THE  LIBRARY 

OF 

THE  UNIVERSITY 

OF  CALIFORNIA 

IRVINE 


EX  L1BRIS 
C.  D.  O'MALLEY,  M.D. 


GILBERTUS  ANGLICUS 

Medicine  of  the  Thirteenth 

Century 

by 

HENRY  E.  HANDERSON,  A.  M.,  M.  D. 
With  a  Biography  of  the  Author 


m 


Published  Posthumously 

FOR  PRIVATE  DISTRIBUTION 

by 

The  Cleveland  Medical  Library  Association 
CLEVELAND,  OHIO 

19  18 


COPYRIGHT.  1918 

by 
The  Cleveland  Medical  Library  Association 


COPY 


of  a  Limited  Edition  of  500  Copies 


Contents 

Page 
Frontispiece    5 

Explanatory  Foreword 7 

Biography    9-14 

Resolutions  of  the  Cleveland  Medical  Library  Ass'n 15 

Gilbertus  Anglicus — A  Study  of  Medicine  in  the  Thirteenth 

Century    17-78 


HENRY  E.  HANDERSON 


Explanatory  Foreword 

In  the  summer  of  1916  the  librarian  of  the  Cleveland  Medical 
Library  received  a  manuscript  from  Dr.  Henry  E.  Handerson  with 
the  request  that  it  be  filed  for  reference  in  the  archives  of  the 
library.  The  librarian  at  once  recognized  the  value  of  the  paper 
and  referred  it  to  the  editorial  board  of  the  Cleveland  Medical 
Journal,  who  sought  the  privilege  of  publishing  it.  Dr.  Hander- 
son's  consent  was  secured  and  the  article  was  set  in  type.  However, 
when  the  time  came  for  its  publication  the  author  was  reluctant  to 
have  it  appear  since  he  was  unable  then  to  read  the  proof,  and  be- 
cause he  felt  that  the  material  present  might  not  be  suitable  for 
publication  in  a  clinical  journal.  To  those  who  knew  him,  this 
painstaking  attention  to  detail  and  desire  for  accuracy  presents  itself 
as  a  familiar  characteristic.  Though  actual  publication  was  postponed, 
the  type  forms  were  oeld,  and  when  the  Cleveland  Medical  Jour- 
nal suspended  publication,  its  editorial  board  informed  the  Council 
of  the  Cleveland  Medical  Library  Association  of  the  valuable 
material  which  it  had  been  unable  to  give  to  the  medical  world.  In 
the  meantime  Dr.  Handerson's  death  had  occurred,  but  the  Council 

obtained  the  generous  consent  of  the  author's  family  to  make  this 
posthumous  publication.  It  is  hoped  that  those  who  read  will  bear 
this  fact  in  mind  and  will  be  lenient  in  the  consideration  of  typo- 
graphical errors,  of  which  the  author  was  so  fearful. 

The  Cleveland  Medical  Library  Association  feels  that  it  is 
fortunate  in  being  enabled  to  present  to  its  members  and  to  others 
of  the  profession  this  work  of  Dr.  Handerson's  and  to  create  from 
his  own  labors  a  memorial  to  him  who  was  once  its  president. 

SAMUEL  W.  KELLEY. 
CLYDE  L.  CUMMER. 

Committee  on  Publication. 


—  7 


HENRY  EBENEZER  HANDERSON 

Owing  to  Dr.  Handerson's  modesty,  even  we  who  were  for 
years  associated  with  him  in  medical  college,  in  organization,  and 
professional  work,  knew  but  little  of  him.  He  would  much 
rather  discuss  some  fact  or  theory  of  medical  science  or  some  ancient 
worthy  of  the  profession  than  his  own  life.  Seeing  this  tall 
venerable  gentleman,  sedate  in  manner  and  philosophical  in  mind, 
presiding  over  the  Cuyahoga  County  Medical  Society  or  the  Cleve- 
land Medical  Library  Association,  few  of  the  members  ever  pictured 
him  as  a  fiery,  youthful  Confederate  officer,  leading  a  charge  at  a 
run  up-hill  over  fallen  logs  and  brush,  sounding  the  "Rebel  yell," 
leaping  a  hedge  and  alighting  in  a  ten-foot  ditch  among  Federal 
troopers  who  surrendered  to  him  and  his  comrades.  Yet  this  is 
history.  We  could  perhaps  more  easily  have  recognized  him  even 
though  in  a  military  prison-pen,  on  finding  him  dispelling  the  tedium 
by  teaching  his  fellow  prisoners  Latin  and  Greek,  or  perusing  a 
precious  volume  of  Herodotus. 

Henry  Ebenezer  Handerson  was  born  on  March  21,  1837,  here 
in  Cuyahoga  county,  in  the  township  of  Orange,  near  the  point 
now  known  as  "Handerson's  Cross-Roads,"  on  the  Chagrin  river. 
His  mother's  maiden  name  was  Catharine  Potts.  His  father  was 
Thomas  Handerson,  son  of  Ira  Handerson.  The  family  immigrated 
to  Ohio  from  Columbia  county,  New  York,  in  1834.  Thos.  Hander- 
son died  as  the  result  of  an  accident  in  1839,  leaving  the  widow  with 
five  children,  the  eldest  thirteen  years  of  age,  to  support.  Henry 
and  a  sister  were  adopted  by  an  uncle,  Lewis  Handerson,  a  druggist. 
of  Cleveland.  In  spite  of  a  sickly  childhood  the  boy  went  to  school 
a  part  of  the  time  and  at  the  age  of  fourteen  was  sent  to  a  boarding- 
school,  Sanger  Hall,  at  New-Hartford,  Oneida  county,  New  York. 
Henry's  poor  health  compelled  him  to  withdraw  from  school.  No 
one  at  that  time  would  have  predicted  that  the  delicate  youth  would 
live  to  be  the  sage  of  four  score  years  and  one.  With  his  foster 
father  and  family  he  moved  to  Beersheba  Springs,  Grundy  county, 
Tennessee. 

In  1854,  in  good  health,  the  boy  returned  to  Cleveland,  pre- 
pared for  college,  and  entered  Hobart  College,  Geneva,  New  York, 

—  9  — 


Biography 

where  he  graduated  as  A.B.  in  1858.  Returning  to  Tennessee,  he 
occupied  himself  for  about  a  year  with  surveying  land  and  in  other 
work  and  then  became  private  tutor  in  the  family  of  Mr.  Washing- 
ton Compton  on  a  cotton  plantation  near  Alexandria,  Louisiana. 
There  he  remained  a  year  or  more,  then  in  the  autumn  of  1860 
matriculated  in  the  Medical  Department  of  the  University  of  Louisi- 
ana (now  Tulane  University),  where  he  studied  through  the  winter, 
and  also  heard  much  of  the  political  oratory  of  that  exciting  period. 

The  bombardment  of  Fort  Sumter,  April  12,  1861,  followed 
by  the  call  of  President  Lincoln  for  75,000  troops  to  suppress  the 
rebellion,  found  young  Handerson  again  employed  as  tutor,  this 
time  in  the  family  of  General  G.  Mason  Graham,  a  veteran  of  the 
Mexican  war. 

With  his  friends  and  acquaintances,  Handerson  joined  a  com- 
pany of  "homeguards"  consisting  mostly  of  planters  and  their  sons, 
formed  for  the  purpose  of  maintaining  "order  among  the  negroes 
and  other  suspicious  characters  of  the  vicinity." 

Many  years  afterward  Dr.  Handerson  wrote,  in  a  narrative  for 
his  family,  concerning  this  period  of  his  life:  "Without  any  dis- 
position to  violent  partisanship,  I  had  favored  the  party  of  which 
the  standard-bearers  were  Bell  and  Everett  and  the  battle  cry  'The 
Constitution  and  the  Union,'  and  I  had  grieved  sincerely  over  the 
defeat  by  the  Radicals  of  the  North,  aided  by  the  'fire-eaters'  of  the 
South." 

And  again :  "Born  and  educated  in  the  North,  I  did  not  share 
in  any  degree  the  fears  of  the  Southerners  over  the  election  to  the 
Presidency  of  Mr.  Lincoln.  I  could  not  but  think  the  action  of  the 
seceding  States  unwise  and  dangerous  to  their  future  prosperity. 
On  the  other  hand,  this  action  had  already  been  taken,  and  without 
any  prospect  of  its  revocation.  Indeed,  in  the  present  frame  of 
mind  of  the  North,  any  steps  toward  recession  seemed  likely  to  pre- 
cipitate the  very  evils  which  the  secession  of  the  states  had  been 
designed  to  anticipate.  I  believed  slavery  a  disadvantage  to  the 
South,  but  no  sin,  and,  in  any  event,  an  institution  for  which  the 
Southerners  of  the  present  day  were  not  responsible.  An  inheritance 
from  their  fore-fathers,  properly  administered,  it  was  by  no  means 
an  unmitigated  evil,  and  it  was  one,  moreover,  in  which  the  North 
but  a  few  years  before  had  shared.  All  my  interests,  present  and 
future,  apparently  lay  in  the  South  and  with  Southerners,  and  if 
the  seceding  States,  in  one  of  which  I  resided,  chose  deliberately  to 
try  the  experiment  of  self-government,  I  felt  quite  willing  to  give 

—  10  — 


Biography 

them  such  aid  as  lay  in  my  feeble  power.  When  I  add  to  this  that 
I  was  24  years  of  age,  and  naturally  affected  largely  by  the  ideas, 
the  enthusiasm  and  the  excitement  of  my  surroundings,  it  is  easy 
to  understand  to  what  conclusions  I  was  led." 

So  on  June  17,  1861,  he  volunteered  in  the  Stafford  Guards 
under  Capt.  (afterward  Brigadier  General)  L.  A.  Stafford.  The 
Guards  became  company  B  of  the  9th  Regiment  of  Louisiana  Vol- 
unteers, Confederate  States  of  America,  Colonel  (later  Brigadier 
General)  "Dick"  Taylor  (son  of  "Old  Zach,"  the  President  of  the 
U.  S.),  in  command.  During  the  year  that  followed  until  the  close 
of  the  war,  Handerson  experienced  the  adventures  and  trials  of  a 
soldier's  life.  He  knew  picket,  scouting,  and  skirmishing  duty,  the 
bivouac,  the  attack  and  defense  in  battle  formation,  the  charge,  the 
retreat,  hunger  and  thirst,  the  wearisome  march  in  heat  and  dust, 
in  cold,  in  rain,  through  swamps  and  stony  wildernesses.  He  was 
shot  through  the  hat  and  clothing  and  once  through  the  muscles  of 
the  shoulder  and  neck  within  half  inch  of  the  carotid  artery,  lay  in 
a  hospital,  and  had  secondary  hemorrhage.  At  another  time  he 
survived  weeks  of  typhoid  fever. 

He  was  successively  private  soldier  and  accountant  for  his 
company,  quarter-master,  2nd  Lieutenant  of  the  line,  Captain  of  the 
line,  and  finally  Adjutant  General  of  the  2nd  Louisiana  Brigade, 
A.  N.  Va.,  under  Lee  and  Jackson,  with  rank  of  Major.  On  May 
4,  1864,  Adjutant  General  Handerson  was  taken  prisoner,  and  from 
May  17th  until  August  20th  he  was  imprisoned  at  Fort  Delaware 
in  the  Delaware  river.  He  was  then  confined  in  a  stockade  enclosure 
on  the  beach  between  Forts  Wagner  and  Gregg  on  Morris  Island, 
until  about  the  end  of  October,  when  he  was  transferred  to  Fort 
Pulaski  at  the  mouth  of  the  Savannah  river,  and  in  March,  1865, 
back  to  Fort  Delaware.  In  April,  after  Lee's  surrender,  many  of 
the  prisoners  were  liberated  on  taking  the  oath  of  allegiance  to  the 
Federal  Government.  But  Handerson  did  not  consider  his  allegi- 
ance to  the  Southern  Confederacy  ended  until  after  the  capture  of 
Presdient  Davis,  and  it  was  not  until  June  17,  1865,  that  he  signed 
the  oath  of  allegiance  and  was  liberated  in  Philadelphia. 

Since  that  time,  with  that  spirit  of  tolerance  and  openness  to 
truth  which  characterized  the  man,  he  has  said,  "in  the  triumph  of 
the  Union,  the  war  ended  as  it  should  have  ended." 

Mr.  Handerson  then  resumed  his  medical  studies,  this  time  in 
the  College   of  Physicians  and   Surgeons  of   New   York,   Medical 

—  11  — 


Biography 

Department  of  Columbia  University,  taking  the  degree  of  M.D.  in 
1867.  Hobart  College  conferred  the  A.M.  in  1868.  On  October 
16,  1872,  he  married  Juliet  Alice  Root,  who  died  leaving  him  a 
daughter. 

February  25,  1878,  Dr.  Handerson  read  before  the  Medical 
Society  of  the  County  of  New  York  an  article  entitled,  "The  School 
of  Salernum,  an  Historical  Sketch  of  Mediaeval  Medicine."  This 
essay  attracted  wide  attention  to  his  scholarly  attainments  and  love 
of  laborious  research.  For  example,  Professor  Edward  Schaer  of 
the  chair  of  Pharmacology  and  Pharmaceutical  Chemistry,  of  Neu- 
munster-Zurich,  pronounces  this  pamphlet  "a  valuable  gift  .  .  .a 
remarkable  addition  to  other  historical  materials  .  .  in  connection 
with  the  history  of  pharmacy  and  of  pharmaceutical  drugs" ;  that  he 
found  in  it  "a  great  deal  of  information  which  will  be  sought  for  in 
vain  in  many  even  renowned  literary  works." 

Dr.  Handerson  practiced  medicine  in  New  York  City,  from 
1867  to  1885,  removing  to  Cleveland  in  1885. 

On  June  12,  1888,  he  married  Clara  Corlett  of  Cleveland. 

Then  in  1889  appeared  the  American  edition  of  the  "History 
of  Medicine  and  the  Medical  Profession,  by  Joh.  Hermann  Baas, 
M.D.,"  which  was  translated,  revised  and  enlarged  by  Dr.  Hander- 
son, to  whom,  in  the  words  of  Dr.  Baas,  "we  are  indebted  for  con- 
siderable amplification,  particularly  in  the  section  on  English  and 
American  medicine,  with  which  he  was,  of  course,  better  acquainted 
than  the  author,  and  for  numerous  corrections."  .  .  .  As  a  matter 
of  fact,  the  learning  and  judgment,  and  the  conscientious  industry 
of  the  translator  and  American  editor  of  this  work  are  evident 
throughout  the  book. 

Concerning  Dr.  Handerson's  writings,  Dr.  Fielding  H.  Garrison 
writes  (Medical  Pickwick,  March,  1915,  P.  118)  :  "The  earliest  of 
Dr.  Handerson's  papers  recorded  in  the  Index  Medicus  is  'An  un- 
usual case  of  intussusception'  (1880).  Most  of  his  other  medical 
papers,  few  in  number,  have  dealt  with  the  sanitation,  vital  statis- 
tics, diseases  and  medical  history  of  Cleveland,  and  have  the  accu- 
racy which  characterizes  slow  and  careful  work.  This  is  especially 
true  of  his  historical  essays  of  which  that  on  The  School  of  Saler- 
num' (1883)  is  a  solid  piece  of  original  investigation,  worthy  to  be 
placed  beside  such  things  as  Holmes  on  homoeopathy,  Weir  Mitchell 
on  instrumental  precision,  or  Kelly  on  American  gynecology. 

"To  the  cognoscenti,  Dr.  Handerson's  translation  of  'Baas'  His- 
tory of  Medicine    (1889)   is  known  as  'Handerson's   Book.'     He 

—  12  — 


Biography 

modestly  describes  himself  as  its  'editor,'  but  he  is  more  than  that. 
As  the  witty  and  effective  translator  of  a  witty  and  effective  work, 
he  has  added  sections  in  brackets  on  English  and  American  history 
which  are  based  on  original  investigation  and  of  permanent  value  to 
all  future  historians.  Handerson's  Baas  is  thus  more  complete  and 
valuable  than  the  Rhinelander's  original  text." 

As  listed  in  the  Index  Medicus,  the  publications  and  writings  of 
Dr.  Handerson  appear  as  follows : 

An  unusual  case  of  intussusception.     Medical  Record,  1880,  xviii,  698. 

The  School  of  Salernum.  An  historical  sketch  of  mediaeval  medicine. 
1883. 

Outlines  of  ihe  history  of  medicine  (Baas).  Translated,  and  in  con- 
junction with  the  author,  revised  and  enlarged,  1887. 

Clinical  history  of  a  case  of  abdominal  cancer.  Cleveland  Medical 
Gazette,  1891-2,  vii,  315-321. 

The  Sanitary  topography  of  Cleveland.  Cleveland  Medical  Gazette, 
1895-6,  xi,  651-659. 

Cleveland  in  the  Census  Reports.  Cleveland  Medical  Gazette,  1896-7. 
xii,  257-264. 

The  earliest  contribution  to  medical  literature  in  the  United  States. 
Janus,  1899,  p.  540. 

A  review  of  the  Vital  Statistics  of  Cleveland  during  the  last  decennium. 
Cleveland  Medical  Journal,  1902,  i,  71-76. 

Epidemics  of  typhoid  fever  in  Cleveland.  Cleveland  Medical  Journal, 
1904,  iii,  208-210. 

The  mortality  statistics  of  the  twelfth  census.  Cleveland  Medical 
Journal,  1905,  iv,  425-431. 

Co-operative  sanitation.     Ohio  Medical  Journal,  1905.  i,  278-281. 

The  medical  code  of  Hammurabi,  King  of  Babylon.  Cleveland  Medical 
Journal,  1908,  vii,  72-75. 

Carcinoma  in  high  life.     Cleveland  Medical  Journal,  1908,  vii,  472-476. 

Medical  Cleveland  in  the  nineteenth  (19th)  Century.  Cleveland  Medical 
Journal,  1909,  viii,  59,  146,  208. 

Gilbert  of  England  and  his  "Compendium  Medicine."  Medical  Pick- 
wick,  1915,   i,   118-120. 

Dr.  Handerson  was  Professor  of  Hygiene  and  Sanitary  Science 
in  the  Medical  Department  of  the  University  of  Wooster,  1894-96, 
and  the  same  in  the  Cleveland  College  of  Physicians  and  Surgeons 
(Medical  Department  of  Ohio  Wesleyan  University),  1896  to  1907, 
and  filled  that  chair  with  eminent  ability.  Thus  it  came  about  that 
the  ex-Confederate  officer  taught  sanitary  science  in  a  college  stand- 
ing upon  ground  donated  by  the  survivors  of  an  organization  of 
abolitionists. 

Dr.  Handerson  was  a  member  of  the  Cuyahoga  County  Medical 
Society,  and  its  President  in  1895 ;  also  a  member  of  the  Cleveland 
Academy  of  Medicine,  of  the  Ohio  State  Medical  Society,  and  of 

—  13  — 


Biography 

the  American  Medical  Association.  He  was  one  of  the  founders 
and  an  active  worker  in  the  Cleveland  Medical  Library  Association 
and  its  President  from  1896  to  1902. 

He  was  all  his  life  devoted  to  the  Episcopal  Church,  was 
Warden  of  Grace  Episcopal  Church,  Cleveland,  for  many  years,  and 
Treasurer  of  the  Diocese  of  Ohio  during  fourteen  years. 

During  his  later  years  Dr.  Handerson  withdrew  entirely  from 
active  practice  and  spent  a  great  deal  of  time  in  his  library.  His 
papers  abound  in  carefully  prepared  manuscripts,  some  of  them 
running  into  hundreds  of  pages. 

Two  years  before  his  death  Dr.  Handerson  became  totally  blind. 
This  grievous  affliction  was  borne  with  unvarying  patience  and 
cheerfulness.  He  still  loved  to  recite  from  memory  the  classic 
authors,  to  relate  and  discuss  episodes  of  world  history  and  events 
of  the  present,  to  solve  difficult  mathematical  problems,  and  to  have 
his  data  on  all  subjects  verified.  He  retained  his  faculties  perfectly 
until  April  23,  1918,  when  he  died  from  cerebral  hemorrhage. 

He  is  survived  by  a  daughter,  two  sons  by  the  second  marriage, 
and  his  devoted  wife. 

Among  numerous  letters  received  from  prominent  physicians 
and  authors  appreciative  of  Dr.  Handerson's  medico-historical  la- 
bors, one  from  Dr.  Oliver  Wendell  Holmes  expresses  high  praise 
and  requests  to  have  sent  to  him  everything  which  Dr.  Handerson 
might  in  future  write. 

Tt  seems  eminently  appropriate  that  the  essay  on  "Gilbertus 
Anglicus,"  the  last  from  the  pen  of  Dr.  Handerson,  should  be  put 
in  book  form,  together  with  a  sketch,  however  brief,  of  its  author's 
earnest  life,  his  sterling  character,  his  geniality  and  imperturbable 
equanimity,  and  thus  preserved  in  testimony  of  the  high  esteem  in 
which  he  was  held  by  his  contemporaries. 

SAMUEL  WALTER  KELLEY. 


—  14 


2fe00Udt0tt0 


At  a  meeting  of  the  Council  of  the  Cleveland  Medical  Library 
Association,  held  on  May  14,  the  following  resolutions  were 
adopted : 

Resolved,  That  in  the  death  of  Dr.  Henry  E.  Handerson  the 
Cleveland  Medical  Library  Association  has  sustained  the  loss  of 
one  of  its  most  honored  and  devoted  members.  His  scholarly 
acquirements  were  notable,  and  his  eminence  as  a  medical  historian 
generally  recognized.  His  deep  interest  in  the  welfare  of  the 
Library  and  his  thorough  attention  to  every  detail  of  his  official 
duties  were  always  evident,  while  his  lovable  personal  qualities 
endeared  him  to  all. 

The  Association  desires  to  express  its  high  appreciation  of  his 
long  and  valued  services,  and  extends  to  his  bereaved  family  its 
heartfelt  and  sincere  sympathy. 

C.  A.  HAM  ANN, 

WM.  EVANS  BRUNER, 

J.  B.  McGEE. 


15  — 


Gilbertus  Anglicus  (Gilbert  of  England) 

A  Study  of  English  Medicine  in  the  Thirteenth 

Century. 

By  H.  E.  Handerson,  A.  M.,  M.  D. 

CLEVELAND 


"Nothing  in  the  past  is  dead  to  the  man  who  would  learn  how  the  pres- 
ent came  to  be  what  it  is." — Stubbs — Constitutional  Hist,  of  England. 


Among  the  literary  monuments  of  early  English  medicine  the 
"Compendium  Medicinae"  of  Gilbertus  Anglicus  merits  a  prominent 
position  as  the  earliest  complete  treatise  on  general  medicine  by  an 
English  author  which  has  been  preserved  to  our  day,  and  equally 
because  it  forms  in  itself  a  very  complete  mirror  of  the  medical 
science  of  its  age  and  its  country. 

Gilbert  was  undoubtedly  one  of  the  most  famous  physicians  of 
his  time.  His  reputation  is  recognized  in  those  well-known  lines  of 
Chaucer  which  catalogue  the  "authorities"  of  his  Doctor  of  Phisik : 

"Wei  knew  he  the  olde  Esculapius 
And  Deyscorides  and  eek  Rufus, 
Olde  Ypocras,  Haly  and  Galyen, 
Serapion,  Razis  and  Avycen, 
Averrois,  Damascien  and  Constantyn, 
Bernard  and  Gatesden  and  Gilbertyn." 

He  is  also  quoted  with  frequency  and  respect  by  the  medical 
writers  of  many  succeeding  ages,  and  the  Compendium,  first  printed 
in  1510,  enjoyed  the  honor  of  a  second  edition  as  late  as  the  seven- 
teenth century  (1608).  The  surname  "Anglicus"  in  itself  testifies 
to  the  European  reputation  of  our  author,  for  as  Dr.  Payne  sensibly 
remarks,  no  one  in  England  would  speak  of  an  English  writer  as 
"the  Englishman." 

Yet,  in  spite  of  his  reputation,  we  know  almost  no  details  of  the 
life  of  Gilbert,  and  are  forced  to  content  ourselves  with  the  few 

—  17  — 


GlLBERTUS   ANGLICUS 

facts  to  be  gleaned  from  the  scanty  biographies  of  early  writers 
and  the  inferences  drawn  from  the  pages  of  the  Compendium  itself. 
The  date  and  place  of  his  birth  and  death,  and  even  the  field  of  his 
medical  activities  are  equally  unknown.  Bale,  Pits  and  Leland,  the 
earliest  English  biographers,  tell  us  that  Gilbert,  after  the  completion 
of  his  studies  in  England,  proceeded  to  the  Continent  to  enlarge  his 
education,  and  finally  became  physician  to  the  great  Justiciar,  Hubert 
Walter,  archbishop  of  Canterbury,  who  died  in  the  year  1205.  This 
would  place  him  under  the  reign  of  King  John,  in  the  early  part  of 
the  thirteenth  century. 

Dr.  John  Freind,  however,  the  famous  English  physician  and 
medical  historian  (1725),  observing  that  Gilbert  quotes  the  Arabian 
philosopher  Averroes  (who  died  in  1198),  and  believing  that  he 
also  quotes  a  work  of  Roger  Bacon  and  the  surgical  writings  of 
Theodorius  (Borgognoni)  of  Cervia  (1266),  was  inclined  to  fix  his 
period  in  the  latter  half  of  the  thirteenth  century,  probably  under 
the  reign  of  Edward  I.  Most  of  the  later  historians  of  medicine 
have  followed  the  views  of  Freind.  Thus  Eloy  adopts  the  date 
1272,  Sprengel  gives  1290,  Haeser  the  same  date,  Hirsch  says  Gil- 
bert lived  towards  the  close  of  the  thirteenth  century,  Baas  adopts 
the  figures  1290,  etc. 

The  most  recent  biographers  of  Gilbert,  however,  Mr.  C.  L. 
Kingford1,  and  the  late  Dr.  Joseph  Frank  Payne2,  after  an  appar- 
ently careful  and  independent  investigation  of  his  life,  have  reached 
conclusions  which  vary  materially  from  each  other  and  from  those 
of  the  historians  mentioned.  Mr.  Kingsford  fixes  the  date  of  Gil- 
bert at  about  1250,  while  Dr.  Payne  reverts  to  the  views  of  Bale 
and  Pits  and  suggests  as  approximate  figures  for  the  birth  and 
death  of  Gilbert  the  years  1170-80  to  1230.  This  discrepancy  of 
twenty-five  or  thirty  years  between  the  views  of  two  competent  and 
unprejudiced  investigators,  as  a  mere  question  of  erudition  and  in- 
terpretation, is  perhaps  scarcely  worthy  of  prolonged  discussion. 
But  as  both  biographers  argue  from  substantially  the  same  data, 
the  arguments  reveal  so  many  interesting  and  pertinent  facts,  and 
the  numerous  difficulties  attending  the  interpretation  of  these  facts, 
that  some  comparison  of  the  different  views  of  the  biographers  and 
some  criticism  of  their  varying  conclusions  may  not  be  unwelcome. 

1.  In  Leslie  Stephen's  "Dictionary  of  Biography." 

2.  British  Medical  Journal,  Nov.  12,  1904,  p.  1282. 

—  18  — 


GlLBERTUS   ANGLICUS 

In  the  first  place  then  we  must  say  that,  as  Gilbert  is  frequently- 
quoted  in  the  "Thesaurus  Pauperum,"  a  work  ascribed  to  Petrus 
Hispanus,  who  (under  the  title  Pope  John  XXI)  died  in  1277,  this 
date  determines  definitely  the  latest  period  to  which  the  Com- 
pendium can  be  referred.  If,  as  held  by  some  historians,  the 
'Thesaurus"  is  the  work  of  Julian,  the  father  of  Petrus,  the  Com- 
pendium can  be  referred  to  an  earlier  date  only. 

Now  Gilbert  in  his  Compendium  (f.  259a)  refers  to  the  writ- 
ings of  Averroes  (Ibn  Roschd)  regarding  the  color  of  the  iris  of 
the  eye.  Averroes  died  in  the  year  1198.  There  is  no  pretense  that 
Gilbert  was  familiar  with  the  Arabic  tongue,  and  the  earliest  trans- 
lations into  Latin  of  the  writings  of  Averroes  are  ascribed  by 
Bacon  to  the  famous  Michael  Scot,  though  Bacon  says  they  were 
chiefly  the  work  of  a  certain  Jew  named  Andrew,  who  made  the 
translations  for  Scot.  Bacon  also  says  that  these  translations  were 
made  "nostris  temporibus,"  in  our  time,  a  loose  expression,  which 
may,  perhaps,  be  fairly  interpreted  to  include  the  period  1230-1250. 
But  if,  as  Dr.  Payne  believes,  Gilbert  died  about  1230,  it  seems  im- 
probable that  he  could  have  been  familiar  with  the  translations  of 
Michael  Scot.  Accordingly  Dr.  Payne  suggests  that,  after  the  death 
of  his  patron  in  1205,  Gilbert  returned  to  the  Continent,  and,  per- 
haps in  Paris  or  at  Montpellier,  met  with  earlier  Latin  versions  of 
the  writings  of  the  Arabian  physician  and  philosopher.  This  is,  of 
course,  possible,  but  there  is  no  historical  warrant  for  the  hypothe- 
sis, which  must,  for  the  present  at  least,  be  regarded  as  merely  a 
happy  conjecture  of  Dr.  Payne.  The  presence  of  Gilbert  upon  the 
Continent,  probably  as  a  teacher  of  reputation,  seems,  however, 
quite  probable.  Littre  has  even  unearthed  the  fact  that  during  the 
14th  century  a  street  in  Paris  near  the  medical  schools,  bore  the 
name  of  the  Rue  Gilbert  l'Anglois.  A  MS.  in  the  Bibliotheque 
Nationale  entitled  "Experimenta  Magistri  Gilliberti,  Cancellarii 
Monte pessulani"  has  suggested  also  the  idea  that  Gilbert  may  have 
been  at  one  time  chancellor  of  the  University  of  Montpellier.  Dr. 
P.  Pansier,  of  Avignon,  however,  who  has  carefully  examined  and 
published  this  manuscript1,  reports  that  while  it  contains  some 
formulae  found  also  in  the  Compendium  of  Gilbert,  it  contains 
many  others  from  apparently  other  sources,  and  he  was  unable  to 
convince  himself  that  the  compilation  was  in  fact  the  work  of  Gil- 
bertus  Anglicus.     Dr.  Pansier  also  furnishes  us  with  a  list  of  the 


1.    Janus,  1903,  p.  20. 

—  19 


GlLBERTUS   ANGLICUS 

chancellors  of  Montpellier,  which  contains  the  name  of  a  certain 
"Gillibertus,"  chancellor  of  the  university  in  1250.  He  could  find, 
however,  no  evidence  that  this  Gillibertus  was  Gilbertus  Anglicus, 
author  of  the  Compendium  Medicinae.  On  the  whole  then  the  visit 
of  Gilbert  to  France  early  in  the  13th  century,  and  his  access  in 
this  way  to  early  translations  of  Averroes,  while  a  convenient  and 
plausible  conjecture  on  the  part  of  Dr.  Payne,  does  not  seem  sup- 
ported by  any  trustworthy  historical  evidence. 

The  "Liber  de  speculis"  mentioned  by  Gilbert  (f.  126  c),  and 
since  the  time  of  Freind  generally  accepted  as  the  work  of  Bacon, 
is  almost  certainly  not  from  the  pen  of  that  eminent  philosopher. 
In  addition  to  the  fact  that  Bacon  himself  says  he  had  (for  obvious 
reasons)  written  nothing  except  a  few  tracts  (capitula  quae  dam) 
prior  to  the  composition  of  his  Opus  Magnum  in  1267,  the  real 
author  of  the  Liber  de  speculis  is  probably  mentioned  by  Bacon  in 
the  following  passage  from  the  Opus  Tertium : 

"Nam  in  hoc  ostcnditur  specialiter  bonitas  naturae,  ut  dicit 
auctor  libri  de  speculis  comburentibus."2 

We  must  therefore  agree  with  Dr.  Payne  that  the  Liber  de 
speculis  of  Gilbert  was  at  least  not  the  work  of  Roger  Bacon. 

Dr.  Freind  regards  the  chapters  of  Gilbert  on  the  subject  of 
leprosy  as  borrowed  substantially  from  the  "Chirurgia"  of  Theo- 
dorius  of  Cervia,  who  wrote  about  the  year  1266.  This  view  has 
also  been  generally  accepted  by  later  writers.  But  Dr.  Payne  boldly 
challenges  the  view  of  Freind,  declares  that  Theodorius  copied  his 
chapters  from  Gilbert,  and  asserts  that  Theodorius  was  a  notorious 
plagiarist.  Now,  while  the  bold  assertion  of  Dr.  Payne  cannot,  of 
course,  be  accepted  as  proof  of  Gilbert's  precedence  in  chronological 
order,  if  that  precedence  is  otherwise  established,  it  will  explain  the 
similarity  of  the  chapters  of  the  two  writers  very  satisfactorily. 
For  the  present,  however,  this  similarity  can  be  adduced  as  evidence 
on  neither  side. 

Again,  Gilbert,  with  the  enthusiasm  of  a  loyal  pupil,  speaks 
(f.  47  b)  of  a  certain  Magister  Ricardus,  "omnium  doctor  urn  doc- 
tissimus,"  whose  views  on  uroscopy  certainly  indicate  a  mind  su- 
perior to  his  age.  Now  there  were  about  this  period  at  least  two 
eminent  physicians  who  bore  the  name  of  Ricardus.  Of  these  the 
senior,  a  Frenchman,  known  also  as  Ricardus  Salednitanus,  is  highly 

2.     Cap.  XXXVI.  p.  116,  edition  of  Brewer. 

—  20  — 


GlLBERTUS    ANGLH 

praised  by  Aegidius  of  Corbeil  (Gilles  de  Corbeil,  Aegidius  Cor- 
boliensis),  physician  to  King  Philip  Augustus  of  France  (1180- 
1223).  This  Ricardus  was  a  famous  teacher  at  Salernum  when 
Aegidius  was  in  attendance  at  that  famous  university,  therefore 
probably  about  the  close  of  the  12th  century.  The  second  Ricardus, 
called  Parisiensis,  has  been  recently  identified  by  Toply  with  Rich- 
ard of  Wendover,  an  English  canon  of  St.  Paul's,  and  at  one  time 
physician  to  Pope  Gregory  IX,  who  died  in  1241.  Toply  believes 
him  to  have  been  also  the  author  of  the  "Anatomia  Ricardi,"  recently 
published.     This  Ricardus  died  in  1252. 

Now  to  which  of  these  Ricardi  does  the  eulogistic  language  of 
Gilbert  refer?  Dr.  Payne  believes  it  to  be  the  senior,  Ricardus 
Salernitanus.  Mr.  Kingsford,  on  the  other  hand,  thinks  it  to  be 
Ricardus  Parisiensis,  who  died  in  1252.  A  Liber  de  urinis  has  been 
ascribed  to  each  of  them,  but,  it  seems  to  me,  with  greater  proba- 
bility to  Ricardus  Salernitanus.  If  too  the  author  of  the  "Anatomia 
Ricardi"  was  a  contemporary  of  Gilbert,  we  might  reasonably  ex- 
pect to  find  in  the  Compendium  some  evidences  of  Gilbert's  ac- 
quaintance with  that  work.  But  Gilbert's  discussion  of  anatomical 
questions  is  totally  unlike  that  of  the  author  of  the  "Anatomia" 
and  betrays  not  the  slightest  evidence  of  knowledge  of  such  a  trea- 
tise. On  the  whole  then  I  am  inclined  to  agree  in  this  question 
with  Dr.  Payne,  and  to  consider  the  Ricardus  of  Gilbert  identical 
with  Ricardus  Salernitanus,  the  famous  professor  of  the  School  of 
Salernum.  This  conclusion  is  further  justified  by  the  fact,  gener- 
ally accepted  by  all  modern  writers,  that  Gilbert  was  himself  a  pupil 
of  Salernum. 

Singularly  enough,  both  Dr.  Payne  and  Mr.  Kingsford  profess 
to  find  in  the  Compendium  some  evidence  that  Gilbert  sojourned  in 
Syria  for  a  certain  period,  though  the  circumstances  of  this  sojourn 
are  viewed  differently  by  the  two  biographers.  Dr.  Payne  thinks 
that  the  physician,  after  completing  his  education  in  England,  pro- 
ceeded to  the  Continent  and  extended  his  travels  as  far  as  Syrian 
Tripoli,  where  he  met  Archbishop  Walter  and  became  attached  to 
his  staff.  As  the  prelate  returned  to  England  in  1192,  this  sojourn 
of  Gilbert  in  Syria  must  have  been  about  1190-91,  when,  according 
to  Dr.  Payne's  chronology,  Gilbert  could  have  been  not  more  than 
about  twenty  years  of  age.  Dr.  Payne  bases  his  story  upon  a  cer- 
tain passage  in  the  Compendium,  in  which  Gilbert  says  that  he  met 
in  Syrian  Tripoli  "a  canonicus  suffering  from  rheumatic  symptoms." 

—  21  — 


GlLBERTUS   ANGLICUS 

I  have  been  entirely  unable  to  find  the  passage  referred  to  in  this 
story,  in  spite  of  a  careful  search  of  the  text  of  the  edition  of  1510. 
But,  admitting  the  existence  of  the  passage  in  question,  it  proves 
nothing  as  to  the  date  of  this  alleged  Syrian  sojourn.  Tripoli  was 
captured  by  the  Crusaders  in  1109,  and  continued  under  their  con- 
trol until  its  recapture  by  the  Saracens  in  1289,  a  period  of  nearly 
two  hundred  years.  Gilbert's  travels  in  Syria  may  then  have  oc- 
curred at  almost  any  time  during  this  long  period,  and  his  fortuitous 
meeting  with  Archbishop  Walter  has  very  much  the  appearance  of 
a  story  evolved  entirely  from  the  consciousness  of  the  biographer. 

On  the  other  hand,  Mr.  Kingsford  bases  his  theory  of  Gilbert's 
sojourn  in  Syria  upon  a  story  adopted,  I  think,  from  Littre  and 
and  found  in  the  Histoire  literaire  de  la  France.  The  Compendium 
of  Gilbert  contains  (f.  137a)  a  chapter  giving  the  composition  of  a 
complex  collyrium  with  which  he  professes  to  have  cured  the  almost 
total  blindness  of  Bertram,  son  of  Hugo  de  Jubilet,  after  the  disease 
had  baffled  the  skill  of  the  Saracen  and  Christian-Syrian  physicians 
of  his  day.  Now  Littre  avers  that  a  certain  Hugo  de  Jubilet  was 
involved  in  an  ambuscade  in  Syria  in  the  year  1227,  and  that  he 
had  a  son  named  Bertram.  It  is  very  natural,  of  course,  to  con- 
clude that  this  Bertram  was  the  patient  recorded  in  the  book  of 
Gilbert.  Kingsford  says  that  Gilbert  "met"  Bertram  in  Syria,  but 
the  text  of  the  Compendium  says  nothing  of  the  locality  of  their 
meeting,  which  might  have  taken  place  almost  anywhere  in  Europe, 
perhaps  even  at  Salernum,  a  favorite  resort  of  the  invalided  Cru- 
saders in  these  times.  Finally.  Dr.  Payne  disposes  effectually  of  the 
authenticity  of  the  entire  story  by  calling  attention  to  the  fact  that 
the  chapter  referred  to  in  the  Compendium  is  marked  plainly 
"Additio,"  without  indicating  whether  this  addition  is  from  the  pen 
of  Gilbert  or  some  later  glossator. 

Finally,  I  may  suggest  another  line  of  argument,  which,  so  far 
as  I  know,  has  not  yet  been  advanced  for  the  determination  of  the 
period  of  Gilbert. 

The  Compendium  Medicinae  of  Gilbert  is,  of  course,  a  com- 
pendium of  internal  medicine.  But  the  book  is  also  something  more. 
Not  less  than  fifty  chapters  are  devoted  to  a  comparatively  full  dis- 
cussion of  wounds,  fractures  and  dislocations,  lithotomy,  hernio- 
tomy, fistulae  and  the  various  diseases  on  the  border  line  between 
medicine  and  surgery.  Not  a  single  surgical  writer,  however,  is 
quoted  by  name.     Nevertheless  the  major  part  of  these  surgical 

—  22  — 


GlLBERTUS    ANGLICUS 

chapters  are  either  literal  copies,  or  very  close  paraphrases,  of  the 
similar  chapters  of  the  "Chirnrgia"  of  Roger  of  Parma,  a  distin- 
guished professor  in  Salernum  and  the  pioneer  of  modern  surgery. 
The  precise  period  of  Roger  is  not  definitely  settled  by  the  unani- 
mous agreement  of  modern  historians,  but  in  the  "Epilogus"  of 
the  "Glosulae  Quatuor  Magistrorum"  it  is  said  that  Roger's  "Chi- 
rurgia"  was  "in  lucem  et  ordincm  redactum"  by  Guido  Arietinus, 
in  the  year  of  our  Lord  1230.  This  date,  while  perhaps  not  un- 
questionable, is  also  adopted  by  De  Renzi,  the  Italian  historian  of 
Medicine.  The  original  MS.  of  Roger's  work  is  said  to  be  still  in 
existence  in  the  Magliabechian  Library  in  Florence,  but  it  has  never 
been  published  in  its  original  form.*  Roland  of  Parma,  however, 
a  pupil  of  Roger,  published  in  1264  what  purports  to  be  a  copy  of 
Roger's  "Chirurgia,"  with  some  notes  and  additions  of  his  own,  and 
it  is  from  this  MS.  of  Roland  that  all  our  copies  of  Roger's  work 
have  been  printed.  Roger's  "Chirurgia"  was  popularly  known  as 
the  "Rogerina;"  the  edition  of  Roland  as  the  "Rolandina."  They 
are  frequently  confounded,  but  are  not  identical,  though  the  addi- 
tions of  Roland  are  usually  regarded  as  of  little  importance.  In  the 
absence  of  Roger's  manuscript,  however,  they  lead  often  to  consid- 
erable confusion,  as  it  is  not  always  easy  to  determine  in  the  printed 
copies  of  the  "Rolandina"  just  what  belongs  to  Roger  and  what  to 
his  pupil  and  editor.  Now  a  careful  comparison  of  the  surgical 
chapters  of  Gilbert  of  England  with  the  published  text  of  the 
"Rolandina"  leads  me  to  the  conviction  that  Gilbert  had  before  him 


*Haeser  says  that  this  MS.  of  Roger's  "Chirurgia,"  made  by  Guido 
Arenitensium,  was  discovered  by  Puccinoti  in  the  Magliabechian  library,  and 
that  an  old  Italian  translation  of  the  same  work  is  also  found  there.  The 
latter  was  the  work  of  a  certain  Bartollomeo. 

The  text  used  to  represent  Roger  in  the  present  paper  is  that  published 
by  De  Renzi  (Collectio  Salernitana,  torn.  II,  pp.  426-493)  and  entitled 
"Rogerii,  Medici  Celeberrimi  Chirurgia."  It  is  really  the  text  published 
originally  in  the  "Collectio  Chirurgica  Veneta"  of  1546,  of  whch  the  preface 
says : 

"His  acceserunt  Rogerii  ac  Guil.  Saliceti  chirurgiae,  quorum  prior  qui- 
busdam  decorata  adnotationibus  nunc  primum  in  lucem  exit,  etc.,  and  adds 
further  on : 

"Addidimas  etiam  quasdam  in  Rogerium  veluti  cxplanationes,  in  anti- 
quissimo  codice  inventas,  et  ab  ipso  fortasse  Rolando  factas."  While  I  may 
recognize  gratefully  the  surgical  enthusiasm  which  led  the  editor  to  the  pub- 
lication of  these  "veluti  explanationes,"  for  my  present  purpose  he  would 
have  earned  more  grateful  recognition  if  he  had  left  them  unprinted.  As  the 
text  now  stands  it  is  merely  a  garbled  edition  of  the  Rolandina.  However, 
it  is  the  best  representative  of  the  "Chirurgia"  of  Roger  at  present  available. 
See  De  Renzi,  op.  cit,  p.  425. 

—  23  — 


GlLBERTUS    AxGLICUS 

the  text  of  Roger,  rather  than  that  of  Roland,  his  pupil.  If  such 
is  the  fact,  Gilbert's  Compendium  must  have  been  written  between 
1230  and  1264,  the  dates  respectively  of  the  "Rogerina"  and' 
"Rolandina." 

From  a  careful  review  of  the  data  thus  presented  we  may  epit- 
omize, somewhat  conjecturally,  the  life  of  Gilbert  substantially  as 
follows :  He  was  probably  born  about  1 180  and  received  his  early 
education  in  England.  On  the  completion  of  this  education,  about 
the  close  of  the  12th  century,  he  proceded  to  the  Continent  to  com- 
plete his  studies,  and  spent  some  time  in  the  school  of  Salernum, 
where  it  is  probable  that  he  enjoyed  the  instruction  of  Roger  of 
Parma,  Ricardus  Salernitanus,  and  may  have  had  among  his  fellow- 
students  Aegidius  of  Corbeil.  Probably  after  his  return  to  England 
he  served  for  a  brief  period  on  the  staff  of  Archbishop  Hubert 
Walter,  after  whose  death  in  1205,  but  at  an  unknown  period,  Gil- 
bert returned  once  more  to  the  Continent,  where  it  seems  probable 
he  spent  the  remainder  of  his  life.  This  comports  best  with  his 
extensive  European  reputation,  his  surname  "Anglicus"  and  the 
comparative  dearth  in  England  of  any  facts  relating  to  his  life. 
The  date  of  the  Compendium  I  am  inclined  to  place  about  1240. 
prior  to  the  literary  activity  of  Ricardus  Parisiensis  or  Richard  of 
Wendover,  Roland  of  Parma,  Roger  Bacon  and  Theodorius  of 
Cervia.     We  may  place  his  death,  conjecturally,  at  about  1250. 

The  first  edition  of  the  Compendium  is  a  small  quarto  of  362 
folios  (724  modern  pages),  five  by  seven  inches  in  size,  printed  in 
double  narrow  columns,  in  black  letter,  perfectly  legible  and  clear. 
The  pagination  shows  some  errors,  but  the  text  itself  is  remarkably 
accurate,  though  the  presence  of  a  multiplicity  of  contractions  and 
ligatures  renders  the  reading  somewhat  difficult  to  the  modern  stu- 
dent.    On  the  last  page  we  find  the  following  colophon : 

Explicit  compendium  medicine  Gilberti  Anglici  correctum  et 
bene  emendatum  per  dominion  Michaelem  de  Capella  artium  ct 
medicine  doctorem:  ac  Lugditni  Impressum  per  Jacobum  Saceon: 
expensis  Vincentii  de  Portonariis.  Anno  Domini  M.  D.  x.  die  vero 
vigesima  mensis  Novcmbris. 

Deo  G ratios. 

The  second  edition  (which  I  have  not  seen)  is  said  to  bear  the 
title:  "Laurea  anglicana,  sive  compendium  totius  medicinae,  etc." 
Geneva,  1608. 

—  24  — 


GlLBERTUS   ANGLICUS 

It  should  be  noticed  that  the  title  "Laurea  anglicana"  is  not 
mentioned  in  the  original  edition  of  1510,  but  is  apparently  due  to 
the  exuberance  of  enthusiasm  of  the  editor  of  the  later  edition, 
whose  taste  seems  to  have  been  more  flamboyant. 

Various  manuscript  works  of  greater  or  less  authenticity  are 
ascribed  to  Gilbert  by  different  authorities.  Of  these  Mr.  Kings- 
ford  furnishes  the  following  list : 

1.  "Commentarii  in  Versus   Aegidii   de   Urinis,"   quoted   by 

John  Gaddesden  and  probably  authentic. 

2.  "Practica  Medicinae,"  mentioned  by  Pits,  but  of  doubtful 

authenticity. 

3.  "Experimenta  Magistri  Gilliberti,  Cancellarii  Montepessu- 

lani,"  noticed  on  page  2,  but  authenticity  doubtful. 

4.  "Compendium  super  Librum  Aphorismorum  Hippocratis." 

MS.  in  Bodleian. 

5.  "Eorundem  Expositio."     MS.  in  Bodleian. 

6.  "Antidotarium."     MS.  in  Caius  College. 

To  these  he  adds,  on  the  authority  of  Bale  and  Pits : 

7.  "De  Viribus  Aquarum  et  Specierum." 

8.  "De  Proportione  Fistularum." 

9.  "De  Judicio  Patientis." 

10.  "De  Re  Herbaria." 

11.  "De  Tuenda  Valentudine." 

12.  "De  Particularibus  Morbis." 

13.  "Thesaurus  Pauperum." 

All  of  these  latter  may  be  regarded  as  doubtful. 

The  authorities  named  by  Gilbert  are  Pythagoras,  Hippocrates, 
Plato,  Aristotle,  Galen,  Rufus,  Maerobius,  Boetius,  Alexander  of 
Tralles,  Theodorus  Priscianus,  Theophilus  Philaretes,  Stephanon 
(of  Athens?),  the  Arabians  Haly  Abbas,  Rhazes,  Isaac  Judaeus, 
Joannitius,  Janus  Damascenus,  Jacobus  Alucindi,  Avicenna  and 
Averroes;  the  Salernian  writers,  quoted  generally  as  Salernitani 
and  specifically  Constantine  Africanus,  Nicholas  Praepositus, 
Romoaldus  Ricardus  and  Maurus,  and  two  otherwise  unknown 
authors,  Torror  and  Funcius,  classed  by  Gilbert  as  "antiqui."  The 
latter  author  is  also  said  to  have  written  a  "Liber  dc  lapidibus." 
Certainly  this  list  suggests  a  pretty  good  medical  library  for  a  prac- 
titioner of  the  13th  century. 

—  25  — 


GlLBERTUS    ANGLICUS 

Dr.  Payne  calls  attention  to  the  fact  that  all  these  writers  ante- 
date the  13th  century,  and  thus  limit  the  period  of  Gilbert  in  an- 
tiquity. This  is  undoubtedly  true  with  reference  to  authorities 
actually  named,  but  does  not  exclude  from  consideration  other 
writers  quoted,  but  not  named,  whom  we  shall  have  occasion  to  refer 
to  hereafter. 

The  Compendium  opens  with  a  very  brief  and  modest  fore- 
word, couched  in  the  following  terms: 

"Incipit  liber  morborum  tarn  universalium  quant  particularium 
a  magistro  Gilberto  anglico  editus  ab  omnibus  autoribus  et  proctitis 
magistrorum  extractus  et  exceptus,  qui  compendium  medicine 
intitulatur ." 

It  will  be  observed  that  no  claim  whatever  for  originality  is 
presented  by  the  author.  He  calls  his  book  a  compendium  extracted 
from  all  authors  and  the  practice  of  the  professors,  and  edited  only 
by  himself.  The  same  idea  is  more  fully  emphasized  later  (f.  55c), 
where  he  says : 

"Sed  consuetudo  nostra  est  ex  dictis  meliorum  meliora  aggre- 
gare,  et  ubi  dubitatio  est,  opiniones  diversas  interserere ;  ut  quisque 
sibi  eligat  quam  velit  retinere." 

The  self-abnegation  implied  in  these  extracts  must  not,  how- 
ever, be  interpreted  too  literally,  for  the  editorial  "dico"  on  numer- 
ous pages,  and  even  an  occasional  chapter  marked  "Propria  opinio," 
testify  to  the  fact  that  Gilbert  had  opinions  of  his  own,  and  was 
ready  on  occasion  to  furnish  them  to  the  profession.  On  the 
whole,  however,  the  "Compendium"  is  properly  classified  by  the 
author  as  a  compilation,  rather  than  an  original  work. 

The  Compendium  is  divided  into  seven  books,  and  the  general 
classification  of  diseases  is  from  head  to  foot — the  usual  method  of 
that  day.  The  modern  reader  will  probably  be  surprised  at  the 
comprehensiveness  of  the  work,  which,  besides  general  diseases, 
includes  considerable  portions  of  physiology,  physiognomy,  ophthal- 
mology, laryngology,  otology,  gynecology,  neurology,  dermatology, 
embryology,  obstetrics,  dietetics,  urinary  and  venereal  diseases, 
therapeutics,  toxicology,  operative  surgery,  cosmetics  and  even  the 
hygiene  of  travel  and  the  prevention  of  sea-sickness.  Some  of  these 
subjects  too  are  discussed  with  an  acuteness  and  a  common  sense 
quite  unexpected.  Of  course,  scholastic  speculations,  superstition, 
charms,  polypharmacy  and  the  use  of  popular  and  disgusting  reme- 

—  26  — 


GlLBERTUS   ANGLICUS 

dies  are  not  wanting.  Even  the  mind  of  a  philosopher  like  Roger 
Bacon  was  unable  to  rise  entirely  above  the  superstition  of  his  age. 
But  the  charms  and  popular  specifics  of  Gilbert  are  often  introduced 
with  a  sort  of  apology,  implying  his  slight  belief  in  their  efficacy. 
Thus  in  his  chapter  on  the  general  treatment  of  wounds  (f.  87a) 
he  introduces  a  popular  charm  with  the  following  words: 

"Alio  modo,  solo  divino  carmine  confisi,  qaidam  experti  posse 
curari  omnes  plagas  hoc. 

Carmine. 

Tres  boni  fratres  per  viam  unam  ibant,  et  obviavit  eis  noster 
dominus  jesus  christus  et  dixit  eis,  tres  boni  fratres  quo  itis,  etc." 

And  again,  in  his  discussion  of  the  treatment  of  gout  and 
rheumatism  (f.  327b),  Gilbert  adds,  under  the  title 

Emperica 
"Quamvis  ego  declino  ad  has  res  parum,  tamen  est  bonum 
scribere  in  libro  nostro,  ut  non  remaneat  tractatus  sine  eis  qnas 
dixrunt  antiqui.  Dico  igitur  quod  dixit  torror:  Si  scinderis  pedem 
rane  viridis  et  ligaveris  supra  pendem  podagrici  per  tres  dies,  curatur; 
ita  quod  dextrum  pedum  rane  ponas  supra  dextrum  pedem  patientis, 
et  e  converso.  Et  dixit  Fundus,  qui  composuit  librum  de  lapidibus, 
quod  magnes,  si  ligatus  fuerit  in  pedem  podagrici,  curatur.  Et 
alius  philosophus  dixit.  Si  accipiatur  calcaneus  asine  et  ponatur 
ligatus  supra  pedem  egri,  curatur,  ita  quod  dexter  supra  dextrum, 
et  e  converso.  Et  juravit  quod  sit  verum.  Et  dixit  torror  quod  si 
ponatur  pes  testudinis  dexter  supra  dextrum  pedem  podagrici,  et  e 
converso,  curatur." 

We  may  believe,  indeed,  that  Gilbert  would  have  preferred  to 
follow  in  the  therapeutic  footsteps  of  Hippocrates,  had  he  not  dis- 
liked to  be  regarded  by  his  colleagues  as  eccentric  and  opinionated. 
For  he  says  in  his  treatment  of  thoracic  diseases  (f.  193c)  : 

"Etenim  eleganter  dedit  Ipo.  (Hippocrates)  modum  curationis, 
sed  ne  a  medicis  nostri  temp  oris  videamur  dissidere,  secundum  eos 
curam  assignemus." 

Gilbert  was  a  scholastic-humoralistic  physician  par  excellence, 
delighting  in  superfine  distinctions  and  hair-splitting  definitions,  and 
deriving  even  pediculi  from  a  superfluity  of  the  humors  (f.  81d). 
Of  course  he  was  also  a  polypharmacist,  and  the  complexity,  inge- 
nuity, and  comprehensiveness  of  his  prescriptions  would  put  to 
shame  even  the  "accomplished  therapeutist"  of  these  modern  days. 

—  27  — 


Gilbert  rs  Anglicus 

In  dietetics  too  Gilbert  was  careful  and  intelligent,  and  upon  this 
branch  of  therapeutics  he  justly  laid  great  emphasis. 

The  first  book  of  the  Compendium,  comprising  no  less  than  75 
folios,  is  devoted  entirely  to  the  discussion  of  fevers.  Beginning 
with  the  definition  of  Joannicius  (Honain  ebn  Ishak)  : 

"Fever  is  a  heat  unnatural  and  surpassing  the  course  of  nature, 
proceeding  from  the  heart  into  the  arteries  and  injuring  the  patient 
by  its  effects." 

Gilbert  launches  out  with  genuine  scholastic  finesse  and  ver- 
bosity into  a  discussion  of  the  questions  whether  this  definition  is 
based  upon  the  essentia  or  the  differentia  of  fever;  whether  the 
heat  of  fever  is  natural  or  unnatural  and  other  similar  subtle  specu- 
lations, and  finally  arrives  at  a  classification  of  fevers  so  elaborate 
and  complex  as  to  be  practically  almost  unintelligible  to  the  modern 
reader. 

The  more  important  of  these  fevers  or  febrile  conditions  are : 

Ephemeral  Quotidian  Tertian 

Hemitertian  Double  tertian  Quartan 

Double  quartan  Quintan  Sextan 

Interpolated  Continued  Synochus 

Synocha  Causon  Synochus  causonides 

Causon  synochides  Putrid  Ethica 

Epilala  Lipparia  Erratica 

Some  of  these  names  are  still  preserved  in  our  nosologies  of 
the  present  day;  others  will  be  recalled  by  the  memories  of  our 
older  physicians,  and  a  few  have  totally  disappeared  from  our 
modern  medical  nomenclature. 

Interpolated  fevers  are  characterized  by  intermissions  and  re- 
missions, and  thus  include  our  intermittent  and  remittent  fevers; 
synochus  depended  theoretically  upon  putrefaction  of  the  blood  in 
the  vessels,  and  was  a  continued  fever.  Synocha,  on  the  other  hand, 
was  occasioned  by  a  mere  superabundance  of  hot  blood,  hence  the 
verse : 

"Synocha  de  midto,  sed  synochus  de  putrefacto." 

Causon  was  due  to  putrefaction  of  bile  in  the  smaller  vessels 

of  the  heart,  diaphragm,  stomach  or  liver,  and  was  an  acute  fever 

characterized  by  furred  tongue,  intolerable  frontal  headache,  tinnitus 

aurium,  constant  thirst,  delirium,  an  olive-colored  face,  redness  and 

—  28  — 


GlLBERTUS    ANGLICUS 

twitching  of  the  eyes  and  a  full,  frequent  and  rapid  pulse.  Epiala 
and  lipparia  were  febrile  conditions  concerning  which  there  seems 
to  have  been  much  difference  of  opinion,  even  in  the  days  of  Gilbert. 
Apparently  they  were  distinguished  by  variations  of  external  and 
internal  temperature,  or  by  chills  combined  with  fever.  Febris 
ethica  is  our  modern  hectic  fever.  In  the  discussion  of  this  last 
variety  we  are  introduced  to  the  "ros"  and  "cambium"  of  Avicenna, 
apparently  varieties  of  hypothetical  humors. 

All  these  fevers  are  regarded  from  the  standpoint  of  Humoral- 
ism,  and  depend  upon  variations  in  the  quantity,  quality,  mixture  or 
location  of  the  four  humors,  blood,  phlegm,  bile  and  black-bile 
{melancholia) . 

In  the  general  treatment  of  febrile  diseases,  so-called  prepara- 
tives and  digestives  are  first  employed  to  ripen  the  humors,  after 
which  evacuatives  (emetics,  cathartics,  sudor ifics,  and  occasionally 
even  venesection)  are  ultilized  for  the  discharge  of  these  peccant 
humors.  Much  emphasis  is  laid  upon  the  dietetics  of  fevers,  and 
this  branch  of  treatment  is  highly  elaborated.  Complications  are 
met  by  more  or  less  appropriate  treatment,  and  the  condition  of  the 
urine  is  studied  with  great  diligence.  Venesection  is  recommended 
rather  sparingly,  and  is  never  to  be  employed  during  the  dies  canicu- 
lar es  (dog-days)  or  dies  Aegyptiaci,  nor  during  conjunctions  of  the 
moon  and  planets,  nor  upon  the  5th,  15th,  17th,  25th,  26th,  or  27th 
days  thereafter,  etc. 

Among  the  complications  of  fevers  discussed  by  Gilbert,  two 
seem  sufficiently  important  to  justify  special  attention.  On  folio 
74b  we  find  a  section  entitled  "De  fluxu  materie  per  parotidas 
venas"  in  which  he  remarks  that  "Sometimes  matter  flows  through 
the  parotid  veins  behind  the  ears  down  to  the  neck  and  nares,  and 
obstructs  the  passages  for  air,  food  and  drink,  so  as  to  threaten 
suffocation."  He  cautions  us  against  the  use  of  repressives,  "lest 
the  matter  may  run  to  the  heart,"  and  recommends  mollitives  and 
dissolvents,  such  as  butter,  dyaltea,  hyssop  and  especially  newly 
shorn  wool  (lana  succida),  which,  he  says,  is  a  strong  solvent.  Is 
this  a  reference  to  the  septic  parotitis  not  unfrequently  seen  in  low 
fevers  ? 

The  following  section,  "De  inflatione  vesice  et  dolore  ejus," 
discusses  the  retention  of  urine  in  fevers,  and  its  treatment.  Gilbert 
says:  "Inflation  of,  and  pain  in  the  bladder  are  sometimes  symp- 
toms of  acute  fevers,  since  the  humors  descend  into  and  fill  the 

—  29  — 


GlLBERTUS    ANGLICUS 

bladder."  If  this  occurs  in  an  interpolated  (remittent)  fever,  he 
directs  the  patient  to  be  placed  in  a  bath  of  a  decoction  of  pellitory 
up  to  the  umbilicus,  "et  effundet  urinam."  If  the  complication  oc- 
curs in  one  suffering  from  a  continued  fever,  the  bath  should  be 
made  of  wormwood  and  a  poultice  should  be  placed  over  the  blad- 
der and  genitals,  "et  statim  minget."  The  same  effect  may  be  pro- 
duced by  poultice  mixed  with  levisticum  (lovage)  or  leaves  of 
parsley.  Singularly  enough  the  catheter  is  not  mentioned,  though 
this  instrument,  under  the  medieval  name  of  argalia  (cf.  French 
algalie),  is  noticed  frequently  in  the  section  devoted  to  vesical  cal- 
culus. 

With  the  second  book  of  the  Compendium  the  system  of  the 
discussion  of  diseases  a  capite  ad  pedes  is  commenced,  and  produces 
some  curious  associates.  To  the  modern  physician  the  sudden  tran- 
sition from  diseases  of  the  scalp  to  fractures  of  the  cranium  seems 
at  least  abrupt,  if  not  illogical.  It  seems,  therefore,  wiser,  in  a  hasty 
review  like  the  present,  to  take  up  the  various  pathological  condi- 
tions described  by  Gilbert  in  their  modern  order  and  relations,  and 
to  thus  facilitate  the  orientation  of  the  reader. 

The  second  book  then  opens  with  a  consideration  of  the  hair 
and  scalp,  and  their  respective  disorders. 

The  hair  is  a  dry  fume  (fumus  siccus),  escaping  from  the  body 
through  the  pores  of  the  scalp  and  condensed  by  contact  with  the 
air  into  long,  round  cylinders.  It  increases  rather  by  accretion  than 
by  internal  growth,  and  its  color  depends  upon  the  humors.  Thus 
red  hair  arises  from  unconsumed  blood  or  bile ;  white  hair,  from  an 
excess  of  phlegm;  black  hair,  from  the  abundance  of  black-bile 
(melancholia) ,  etc.  The  use  of  the  hair  is  for  ornament,  for  pro- 
tection and  for  the  distinction  of  the  sexes.  Numerous  prescrip- 
tions for  dyeing  the  hair,  for  depilatories  (psilothra),  for  the  re- 
moval of  misplaced  hair  and  for  the  destruction  of  vermin  in  the 
hair  are  carefully  recorded. 

Three  varieties  of  soaps  for  medicinal  use  are  described,  and 
the  process  of  their  manufacture  indicated.  The  base  of  each  is  a 
lixivium  made  from  two  parts  of  the  ashes  of  burned  bean-stalks 
and  one  of  unslaked  lime,  mixed  with  water  and  strained.  Of  this 
base  (capitellum) ,  two  parts  mixed  with  one  part  of  olive  oil  form 
the  sapo  saracenicus.  In  the  sapo  g alliens  the  base  is  made  with 
the  ashes  of  chaff  and  bean-stalks  with  lime,  and  to  it  is  added 
goat's  fat,  in  place  of  the  oil.     The  sapo  spatarenticus  is  made  in 

—  30  — 


(  rILBERTUS    ANGLICUS 

a  similar  manner,  except  that  oil  replaces  the  goat's  fat  and  the 
soap  is  made  only  during  the  dog  days,  since  the  necessary  heat  is 
to  be  supplied  by  the  sun  alone. 

Among  the  diseases  of  the  scalp  attention  is  given  to  alopecia, 
dandruff  (furfur),  tinea  caries  and  various  pustular  affections, 
fanus  (favus),  rima,  spidecia,  achora,  etc.  Caries  was  a  pustular 
disease,  in  which  bristle-like  hairs  formed  a  prominent  feature. 
Rima  was  a  name  applied  by  the  physicians  of  Salernum  to  a  super- 
fluity of  hair.  In  addition  to  these  diseases  of  the  scalp,  we  find 
also  descriptions  of  gutta  rosacea,  morphoea  and  scabies,  a  fairly 
extensive  dermatology  for  this  early  day.  In  favus,  Gilbert  tells  us 
that,  after  the  removal  of  the  pustules,  there  remain  foramina,  from 
which  exudes  a  poisonous  substance,  resembling  honey.  Of  course 
his  system  of  treatment  is  rich  in  variety  and  comprehensiveness. 

We  may  notice  here  too  a  few  chapters  on  Toilet  or  Decorative 
Medicine,  a  branch  of  art  to  which  modern  physicians  have  devot- 
ed perhaps  too  little  attention,  with  the  natural  result  that  it  has 
fallen  largely  into  the  hands  of  charlatans  of  both  sexes.  Gilbert's 
chapter  "De  ornatu  capillorum"  offers  the  following  sensible  intro- 
duction :  "The  adornment  of  the  hair  affords  to  women  the  import- 
ant advantages  of  beauty  and  convenience;  and  as  women  desire 
to  please  their  husbands,  they  devote  themselves  to  adornment 
and  protect  themselves  from  the  charge  of  carelessness.  In  order, 
therefore,  that  our  ministry  may  not  be  depreciated,  and  that  we 
may  not  render  ourselves  liable  to  the  accusation  of  ignorance,  let 
us  add  a  few  words  on  the  subject  of  the  dressing  of  the  hair  and 
the  general  care  of  the  person". 

Accordingly  Gilbert  advises  ladies  who  desire  to  retain  or  renew 
the  charms  of  youth  to  soften  the  skin  and  open  its  pores  by  the 
use  of  steam  baths  and  careful  washing  in  warm  water,  followed 
by  drying  the  surface  with  the  finest  cloths  (panno  mimdissimo) . 
If  necessary,  superfluous  hair  is  to  be  removed  by  suitable  depila- 
tories, color  to  be  restored  to  the  pale  cheeks  by  a  lotion  of  chips 
of  Brazil-wood1  soaked  in  rose-water  and  applied  with  pads  of 
cotton;  or,  if  the  face  is  too  red,  it  may  be  blanched  by  the  root 
of  the  cyclamen  (panis  porcinus,  sowbread)  dried  in  an  oven  and 
powdered.     A  wealth  of  remedies  for  freckles,  moles,  warts,  wrin- 


1.  This  apparent  anachronism  carries  us  back  to  the  history  of  the  myth- 
ical Island  of  Brazil,  which  appeared  upon  our  charts  as  late  as  the  middle 
of  the   19th  century. 

—  31  — 


GlLBERTUS    ANGLICUS 

kles,  discolorations  and  other  facial  blemishes,  with  foul  breath 
and  fetidity  of  the  armpits,  is  carefully  recorded,  and  would  suffice 
to  establish  the  fortune  of  any  of  our  modern  specialists  in  female 
beauty.  Finally  a  long  chapter  entitled  "Dc  sophistication  vulvae" 
introduces  us  to  a  phase  of  decoration  and  sophistication  which  I 
would  fain  believe  little  known  or  studied  in  the  development  of 
modern  civilization,  in  which  we  are  prone  at  least  to  follow  the 
advice  of  Hamlet,  to 

"Assume  a  virtue,  if  you  have  it  not." 

At  all  events,  we  may  congratulate  ourselves  that  the  details  of  these 
disgusting  cess-pools  of  medical  art  have  disappeared  entirely  from 
the  pages  of  our  modern  text-books.  Even  Gilbert  considers  it  ad- 
visable to  preface  this  gruesome  chapter  with  a  sort  of  ''Caveat 
emptor"  apology  to  the  reader : 

"Ut  tamen  secundum  ordinem  procedamus,  in  primis  cognos- 
actur  cognoscere  dcsidcrantibus,  ne  dolus  dolo  patrocinetur,  vel 
simplex  dolose  muscipula  claudatur." 

In  the  department  of  neurology  Gilbert,  after  a  philosophical 
discussion  of  the  nature  and  variety  of  pain,  devotes  considerable 
chapters  to  the  causes,  symptoms,  diagnosis  and  treatment  of  head- 
ache, hemicrania,  epilepsy,  catalepsy,  analepsy,  cerebral  congestion, 
apoplexy  and  paralysis,  phrenitis,  mania  and  melancholia,  incubus 
or  nightmare,  lethargy  and  stupor,  lippothomia  or  syncope,  sciatica, 
spasm,  tremor,  tetanus,  vertigo,  wakefulness,  and  jectigation  (jacti- 
tation, formication,  twitching). 

The  third  book  of  the  Compendium  opens  with  several  chapters 
on  the  anatomy  and  physiology  of  the  eye  and  the  phenomena 
of  vision.  According  to  Gilbert,  the  eye  consists  of  three  humors, 
the  albugineous  (aqueous),  the  crystalline  lens  and  the  vitreous 
humor,  and  seven  tunics,  apparently 

1.  The  conjunctiva 

2.  The  albuginea  or  sclerotic 

3.  The  cornea 

4.  The  secundina  (choroid) 

5.  The  rethilea  (retina) 

6.  The  aranea  (iris) 

7.  The  uvea  perforata  (posterior  layer  of  iris), 

though  the  definitions  are  not  in  all  cases  quite  clear  and  definite. 
The  tela  aranea  is  said  to  take  its  origin  from  the  retina,  the  retina 

—  32  — 


GlLBERTUS   ANGLICUS 

from  the  optic  nerve,  and  the  latter  from  the  rethi  (rete,  network) 
involving  the  substance  of  the  brain.  The  cornea  arises  from  the 
sclerotic  tunic,  the  uvea  and  secundina  take  their  origin  from  the  pia 
mater,  and  the  conjunctiva  from  a  thin  pellicle  or  membrane  which 
covers  the  exterior  of  the  cranium  and  is  nourished  by  a  transuda- 
tion of  the  blood  through  the  coronal  suture.  This  pellicle  is  also 
said  to  have  a  connection  with  the  heart,  which  arrangement  fur- 
nishes a  decidedly  curious  explanation  of  the  mechanism  of  sympa- 
thetic and  maudlin  lachrymation.  For,  as  Gilbert  tells  us,  when  the 
heart  is  compressed  this  pellicle  is  also  compressed,  and  if  any  moist- 
ure is  found  beneath  the  pellicle  it  is  expressed  into  the  substance 
of  the  lachrymal  gland  by  the  constriction  of  the  heart,  and  men  in 
sorrow  therefore  shed  tears.  And  again,  if  the  heart  is  much  dilated 
or  elevated  (by  joy),  this  pellicle  is  also  dilated  or  elevated,  and  if 
any  moisture  is  found  beneath  it,  it  is  expressed  in  the  form  of 
tears.  Accordingly,  men  who  are  too  joyful  shed  tears.  Still 
further,  drunken  men,  who  are  notoriously  "moist,"  and 
have  a  superfluity  of  fluid  between  the  pellicle  and  the  skin  of 
the  cranium,  are  prone  to  weeping  on  slight  provocation,  and  their 
tears  are  nothing  more  than  an  expression  of  this  moisture,  which 
makes  its  exit,  not  through  the  substance  of  the  eye,  but  through  the 
"lachrymal  angle."     Q.  E.  D. 

This  odd  demonstration  is  followed  by  a  succession  of  optical 
questions,  which  are  discussed  and  answered  in  true  scholastic  style, 
with  no  little  acuteness  of  observation.  Thus:  "Utrum  visus  fiat 
intus  suscipiendof"  Is  vision  accomplished  by  something  received 
into  the  eye?  "Utrum  color  fit  de  nocte?"  Does  color  exist  at 
night?  To  the  latter  question  Gilbert  replies  that  in  the  darkness 
color  exists  in  posse,  but  not  in  esse.  Again :  "Why  do  some  ani- 
mals see  at  night,  some  in  the  day  only  and  some  only  in  the  twi- 
light?" This  phenomenon  he  ascribes  to  "the  clearness  and  subtilty 
of  the  visual  spirits,  or  to  the  strength,  weakness,  grossness  or 
turbidity  of  the  organs  of  vision."  Some  animals,  he  says,  have 
(visual)  spirits,  subtle  and  clear  as  fire,  and  these  animals  see  per- 
fectly at  night  because  the  visual  spirits  (spiritus  visibilis)  are  suffi- 
cient to  illuminate  the  external  air.  "Why  do  objects  in  water 
seem  nearer  than  those  in  air?"  Gilbert  explains  this  as  follows: 
"Nothing  appears  distant,  except  as  perceived  through  an  extensive 
intervening  medium.  But  our  judgment  is  largely  guided  by  the 
transparency  of  this  medium,  since  the  medium  itself  is  not  per- 

—  33  — 


GlLBERTUS   ANGLICUS 

ceived  with  much  accuracy,  except  when  it  is  transparent.  Accord- 
ingly, as  the  lucidity  of  air  is  greater  than  that  of  water,  an  object 
looks  more  distant  through  air  than  through  water." 

"Why  does  not  a  single  object  appear  double,  inasmuch  as  we 
have  two  eyes?"  To  this  he  replies:  "From  the  anterior  part  of 
the  brain  two  optic  nerves  pass  to  the  two  eyes.  But  these  two 
nerves  unite  at  a  certain  point  into  one.  Now,  since  the  two  nerves 
are  of  equal  length,  two  images  proceeding  from  a  single  object  do 
not  make  the  object  seem  double,  but  single,  since  the  two  images 
are  united  into  one,  and  accordingly  one  object  is  seen  as  one 
image." 

Other  physiological  speculations  are  introduced  by  the  ques- 
tions:  "May  one  see  an  object  not  actually  present?"  "Why  do 
some  animals  see  best  objects  at  a  distance,  others  those  near  at 
hand?"  "Why  are  objects  seen  in  their  proper  position?"  All 
these  questions  are  answered  in  accordance  with  the  scholastic 
formulae,  and,  not  infrequently,  with  considerable  acuteness. 

A  chapter  entitled  "De  signis  oculorum"  also  introduces  us  to  a 
curious  discussion  of  ocular  physiognomy.     Thus : 

"When  we  see  a  man  with  large  eyes,  we  argue  that  he  is  in- 
dolent." 

"If  his  eyes  are  deeply  situated  in  his  head,  we  say  that  he  is 
crafty  and  a  deceiver." 

"If  his  eyes  are  prominent,  we  say  that  he  is  immodest,  loquac- 
ious and  stupid." 

"He  whose  eyes  are  mobile  and  sharp  is  a  deceiver,  crafty  and 
a  thief." 

"He  whose  eyes  are  large  and  tremulous  is  lazy  and  a  braggart 
{spaciosusf),  and  fond  of  women." 

and  so  forth  for  an  entire  page  of  the  Compendium. 

Actual  diseases  of  the  eye  are  discussed  in  chapters  on  pain  in 
the  eyes,  ophthalmia,  pannus  (including  ungula,  egilops  and  cata- 
ract), tumors,  of  the  conjunctiva,  itching  of  the  eyes,  lachrymation, 
cancer,  diseases  of  the  cornea  and  uvea,  diseases  of  the  eyelids, 
lachrymal  fistula  and  entropion.  The  treatment  consists  generally 
in  ointments  and  collyria  in  abundance,  but  in  fistula  lachrymalis 
incision  and  tents  of  alder-pith,  mandragora  {malum  terrae),  briony, 
gentian,  etc.,  are  recommended,  and  entropion  is  referred  directly 
to  the  surgeon. 

—  34  — 


'.ILDERTUS    ANGLICUS 

The  Latin  term  cataracta  (also  catarracta  and  catarractes)  is  applied  to 
a  disease  of  the  eyes  by  Gregory  of  Tours  (Hist.  Franc,  v.  6)  as  early  as 
A.  D.  650,  and  again  by  Constantine  Africanus,  of  the  school  of  Salernum, 
in  1075  (De  Chirurg.,  cap.  XXX).  Singularly  the  word  is  not  found  in  the 
"Chirurgia"  of  Roger  of  Parma,  from  whom  Gilbert  seems  to  have  borrowed 
most  of  his  surgical  knowledge.  Nor  is  it  employed  by  Roland,  Roger's 
pupil  and  editor.  It  recurs,  however,  in  the  Glossulae  Quatuor  Magistrorum 
(about  1270).  But  in  all  these  writers  cataracta  seems  to  be  included  under 
the  general  term  pannus,  meaning  opacities  of  every  kind.  Indeed  Gilbert 
says,  "Ungula,  egilops,  cataracta  and  macula  are  species  of  pannus,  all  arising 
from  the  same  causes  and  cured  by  the  same  treatment."  A  few  lines  later, 
however,  in  distinguishing  these  various  species,  he  adds :  "Cataract  arises 
from  a  humor  collected  between  the  tunics  of  the  eye" :  and  again  it  is  said 
to  be  blood  filling  the  veins  of  the  eyes,  and  especially  those  of  the  conjunc- 
tiva, and  derives  its  name  a  caracteribus  (?).  The  truth  is  none  of  these 
writers  seem  to  have  any  very  definite  knowledge  of  the  distinction  between 
the  various  opacities  of  the  media  of  the  eye,  all  of  which  were  included 
under  the  general  term  pannus.  But,  what  is  more  remarkable,  Roger,  Roland 
and  The  Four  Masters  make  no  mention  of  the  possibility  of  surgical  inter- 
ference in  these  cases,  but  content  themselves  with  elaborate  collyria  and 
ointments,  or  simply  with  internal  treatment.  Gilbert,  on  the  other  hand, 
while  recommending  these  collyria  and  ointments,  and  even  the  internal 
remedies,  adds  the  following: 

"Interior  autem  macula,  quae  tela  vocatur,  subcornea  situata,  si  vl'c  (?) 
purgatione  precendente  ct  colliriis  et  pulveribus  non  removetur,  acu  torta 
immissa  per  caprmum  angulum  extrahatur  aut  inferius  replicetur"  (f.  137a). 

And  again  (f.  141d)  : 

"In  uvea  sunt  largitas  et  constrictio  et  aqua  sive  cataracta.  .  .  .  Aqua 
quandoque  per  medium  pupille  descendit,  inferius  stans,  subuvea  apparcns, 
quae  perfecte  curatur  secundum  quosdam  immisso  acus  aculeo  per  pupillam, 
ut  extra  ftuat  aqua." 

Chapters  on  the  physiology  of  hearing,  smelling  and  the  sensa- 
tion of  touch  are  followed  by  a  discussion  of  the  symptoms  and 
treatment  of  earache,  abscess  of  the  ear,  discharges  (bloody  and 
sanious)  from  the  ear,  worms  and  other  foreign  bodies  in  the  ear, 
tinnitus  aurium,  deafness,  coryza,  epistaxis,  nasal  polypi,  ozaena, 
cancer  of  the  nose,  fissures  and  ulcers  of  the  lips,  foul  breath,  dis- 
eases of  the  tongue,  toothache,  etc. 

Physiognomy,  a  favorite  theme  with  our  author,  appears  again 
in  a  considerable  chapter  on  the  physiognomy  of  the  nose,  mouth, 
face  and  the  teeth. 

"He  who  laughs  frequently  is  kind  and  genial  in  all  things  and 
is  not  worried  over  trifles." 

"He  who  laughs  rarely  is  contrary  and  critical." 
"He  who  has  large  ears  is  stolid  and  long-lived." 
"He  who  has  a  large  mouth  is  gluttonous  and  daring." 
"He  whose  teeth  are  defective  and  small  is  weak  in  his  whole 
body." 

—  35  — 


GlLBERTUS   ANGLICUS 

"He  whose  canine  teeth  are  long  and  straight  is  a  glutton  and 
a  rascal." 

The  department  of  genito-urinary  diseases  is  introduced  by  a 
long  chapter  entitled  "De  approximeron,"  a  formidable  Latin  word 
defined  by  Gilbert  as  sexual  impotence.  An  elaborate  discussion  of 
the  physiology  of  generation  and  the  phenomena  of  impotence  is 
followed  by  a  collection  of  remedies  for  the  condition,  of  which  the 
best  that  can  be  said  is  that  they  are  probably  no  less  effective  than 
most  of  the  modern  drugs  recommended  for  the  same  purpose. 
Concerning  a  function  over  which  so  many  fond  superstitions  still 
linger  in  the  public  mind  we  may,  perhaps,  charitably  forgive  Gil- 
bert for  the  introduction  of  an  empirical  remedy  for  sterility,  which, 
he  assures  us,  he  has  often  tried  and  with  invariable  success,  and 
which  enjoys  the  double  advantage  of  applicability  to  either  sex. 

"Let  a  man,  twenty  years  of  age  or  more,  before  the  third  hour 
of  the  vigil  of  St.  John  the  Baptist,  pull  up  by  the  roots  a  specimen 
of  consolida  major  (comfrey)  and  another  of  consolida  minor 
(healall),  repeating  thrice  the  Lord's  prayer  {oratio  dominica) 
Let  him  speak  to  no  one  while  either  going  or  returning,  say 
nothing  whatever,  but  in  deep  silence  let  him  extract  the  juice  from 
the  herbs  and  with  this  juice  write  on  as  many  cards  as  may  be 
required  the  following  charm  : 

Dixit  dominus  crescite.  f.  Uthihoth.  f .  maltiplicamini.  f . 
thahechay.     f .     et  replete  t errant,     f .     amath. 

If  a  man  wears  about  his  neck  a  card  inscribed  with  these 
identical  words  written  in  this  juice,  he  will  beget  a  male.  Con- 
versely, if  a  woman,  she  will  conceive  a  female"  (f.  287b). 

Gilbert,  however,  cautions  the  bearer  of  this  potent  charm  of 
the  possible  dangers  of  satyriasis  incurred  thereby,  and  offers  suit- 
able remedies  for  so  alarming  a  condition. 

Chapters  on  satyriasis,  gomorrhea  (gonorrhea  in  its  etymolog- 
ical sense,  seminal  emissions),  with  a  third  entitled  "De  pustulis  et 

I.  In  his  chapter  on  embryology  (f.  304c)  Gilbert  describes  the  lrili 
vein  as  follows :  "The  embryo  is  nourished  by  means  of  the  lrili  or  lrineli 
vein,  which  does  not  exist  in  man.  This  vein  has  its  origin  in  the  liver  and 
divides  into  two  branches.  Of  these  the  superior  branch  bifurcates,  and  one 
of  its  branches  goes  to  the  right  breast,  the  other  to  the  left,  conveying  blood 
from  the  liver.  This  blood  in  the  breast  is  bleached  white  (dealbatiir)  like 
milk,  and  forms  the  nourishment  of  the  infant.  The  inferior  branch  of  the 
lrili  vein  also  bifurcates,  sending  one  of  its  branches  to  the  right  cornu.of 
the  uterus,  the  other  to  the  left.  These  vessels  carry  blood  into  the  cotyle- 
dons, whence  it  is  transmitted  to  the  fetus  and  digested  by  its  digestive 
faculty." 

—  36  — 


GlLBERTUS    ANGLICUS 

apostematibus  virgae"  complete  this  department  of  medical  art.  The 
last  chapter  recognizes  the  venereal  origin  of  the  pustules  and  ulcers 
discussed,  but  furnishes  no  direct  evidence  of  Gilbert's  belief  in  the 
existence  of  a  specific  venereal  poison. 

While  Gilbert  is  very  scrupulous  in  his  examination  of  the  gross 
appearances  of  the  urine  in  most  diseases,  his  discussion  of  the  dis- 
eases of  the  kidneys  and  bladder  includes  only  pain  in  the  kidneys, 
abscess  of  the  kidneys,  renal  and  vesical  calculus,  hematuria,  incon- 
tinence of  urine,  dysuria  and  strangury. 

The  chapter  on  hematuria  presents  a  very  curious  specimen  of 
medieval  pathology.  Gilbert  says :  "The  escape  of  blood  in  the 
urine  is  due  sometimes  to  the  liver,  sometimes  to  the  bile,1  sometimes 
to  the  kidneys  and  loins,  sometimes  to  the  bladder.  If  the  blood  is 
pure  and  clear,  in  large  quantity,  mixed  perfectly  with  the  urine  and 
accompanied  by  pain  in  the  right  hypochondrium,  it  comes  from 
the  liver.  Such  urine  presents  scarcely  any  sediment.  If  the  blood 
comes  from  the  lrili  vein,  it  is  also  rather  pure,  but  less  pure  than 
in  the  former  case,  nor  is  the  quantity  so  great,  while  pain  is  felt 
over  the  region  of  the  seventh  vertebra,  counting  from  below.  If  it 
comes  from  the  kidneys,  it  is  scanty  and  pure  as  it  leaves  the  bladder, 
but  soon  coagulates  and  forms  a  dark  deposit  in  the  vessel,  while 
pain  is  felt  in  the  pubes  and  peritoneum.  ...  If  pus,  blood 
and  epithelium  {squamae)  are  passed,  and  the  odor  is  strong,  it 
signifies  ulceration  of  the  bladder"  (f.  275b). 

Diabetes  is  defined  as  "An  immoderate  passage  or  attraction  of 
urine  from  the  liver  to  the  kidneys  and  its  passage  through  the  kid- 
neys, as  the  result  of  a  warm  or  dry  distemperature  of  these  or- 
gans." The  idea  of  some  association  of  the  liver  and  kidneys  in 
the  production  of  diabetes  is  at  least  as  old  as  the  eleventh  century, 
and  Gilbert's  definition  of  the  disease  is  undoubtedly  borrowed  from 
the  "Practica"  of  John  Platearius  (A.  D.  1075),  of  the  school  of 
Salernum.  The  symptoms,  continual  thirst,  dryness  of  the  mouth, 
emaciation,  in  spite  of  an  inordinate  appetite,  frequent  and  profuse 
urination,  are  correctly  given,  but  no  knowledge  of  the  presence  of 
sugar  in  the  urine  is  indicated. 

Dyampnes  (involuntary  micturition)  claims  a  page  or  more  of 
explanation  and  treatment,  and  its  frequent  occurrence  in  old  men 
and  children  is  noticed. 

In  the  department  of  the  diseases  of  women  chapters  are  de- 

—  37  — 


GlLBERTUS    ANGLICUS 

voted  to  amenorrhea,  menorrhagia,  hysteria  (stiff  ocatio  matricis), 
prolapse,  ulceration,  abscess,  cancer,  dropsy  and  "ventosity"  of  the 
uterus  (physometra). 

In  the  allied  department  of  obstetrics  we  find  chapters  on  the 
signs  of  conception,  on  the  urine  in  pregnant  women,  on  difficult 
labor,  prolapsus  uteri,  retention  of  the  placenta,  post  partum  hem- 
orrhage, afterpains,  and  the  oedema  of  pregnancy.  The  causes  of 
difficult  labor,  according  to  Gilbert,  are  malposition,  dropsy,  im- 
moderate size  and  death  of  the  fetus,  debility  of  the  uterus  and 
obstruction  of  the  maternal  passages.  Malpositions  are  to  be  cor- 
rected by  the  hand  of  the  midwife  (obstctrix).  Adjuvant  meas- 
ures are  hot  baths,  poultices,  inunctions,  fumigations  and  sternuta- 
tories, and  the  use  of  certain  herbs. 

In  the  departments  of  general  medicine  not  as  yet  entirely  ap- 
propriated by  specialists  it  will  suffice  to  mention  scrofula,  pleurisy 
and  pneumonia,  hemoptysis,  empyema,  phthisis,  cardiac  affections, 
diseases  of  the  stomach,  liver  and  spleen,  diarrhoea  and  dysentery, 
intestinal  worms,  dropsy,  jaundice,  cancer,  rheumatism  and  gout, 
small-pox,  measles,  leprosy  and  hydrophobia,  all  of  which  claim 
more  or  less  attention. 

Peripneumonia  and  pleurisy  arc  both  inflammations  of  the  chest, 
the  former  affecting  the  lungs,  the  latter  the  diaphragm  and  the  pelli- 
cle which  lines  the  ribs.  The  prominent  symptoms  of  both  diseases 
are  pain  in  the  chest  or  side,  cough  and  fever  and  dyspnoea.  Acci- 
dents or  sequelae  are  hemoptysis,  empyema  and  phthisis. 

Empima  (empyema)  is  the  hawking-up  of  sanies,  with  infec- 
tion of  the  lung  and  a  sanious  habit.  Hence  persons  laboring  under 
pneumonia  or  pleurisy  are  not  necessarily  empyemics,  but  when 
these  diseases  progress  to  such  a  point  that  blood  and  sanies  are 
expectorated  and  the  lung  is  infected,  that  is  when  the  ulceration  of 
the  lungs  fails  to  heal  and  corruption  and  infection  occur,  the  dis- 
ease becomes  empima,  and  is  with  difficulty,  or  never  cured. 

Ptisis  is  a  substantial  consumption  of  the  humidity  of  the  body, 
due  to  ulceration  of  the  lungs.  For  when  a  solution  of  continuity 
occurs  in  the  lungs,  the  inspiratory  and  expiratory  forces  fail. 
Hence  the  lungs  no  not  inspire  sufficient  air  to  mitigate  the  innate 
heat  of  the  heart,  and  the  heart  fails  to  purify  itself  of  the  fumosity 
or  fumous  vapors  generated  in  itself.  Accordingly,  deprived  of  the 
means  of  mitigating  its  heat  or  ventilating  its  fumosities,  the  spirits 
within  it  become  unduly  heated,  and  a  consuming  fire  is  generated 
in  the  entire  body. 

—  38  — 


(  rILBERTI  S    ANGLICUS 

The  symptoms  of  ptisis  are  a  continued  fever,  greater  or  less, 
detected  in  the  palms  of  the  hands  and  the  soles  of  the  feet,  thirst, 
a  roughness  of  the  tongue,  slenderness  of  the  neck,  wasting  of  the 
entire  body,  constipation,  wasting  and  shrinking  of  the  finger-nails 
and  fingers,  hollowness  of  the  eyes,  pain  in  the  left  scapula  extend- 
ing to  the  shoulder,  pharyngeal  catarrh  with  abundant  and  mucil- 
aginous sputum  and  a  tendency  to  lachrymation.  If  the  sputum 
thrown  upon  the  coals  emits  a  fetid  odor,  it  is  a  sign  of  confirmed 
ptisis,  which  is  incurable.  The  disease  when  it  occurs  in  youths 
and  young  persons  rarely  lasts  longer  than  a  year,  often  terminates 
in  less  time,  and  may  sometimes,  by  the  aid  of  medicine,  be  pro- 
longed for  a  greater  period.  If  the  sputum  received  during  the 
night  in  a  vessel  is  flushed  in  the  morning  with  warm  water,  while 
some  impurities  remain  upon  the  surface,  the  putrid  matter  will 
sink  to  the  bottom  (sputum  fundum  petens),  and  the  indications 
are  fatal.  Likewise  sharpness  of  the  nose,  hollow  eyes,  slender 
nails,  falling  hair,  flattened  temples  and  diarrhoea  are  of  evil  omen. 
These  patients  converse  while  dying,  and  die  conversing  (moriendo 
loquentur,  sed  loquendo  moriuntur) .  Gilbert,  of  course,  supplies  a 
formidable  array  of  remedies  for  the  disease,  but  tells  us  that  the 
"very  latest"  is  cauterization  over  the  clavicles  (N  ovissimum  ant  em 
consilium  est  cauterium  in  furcula  pectoris). 

The  varieties  of  difficulty  of  breathing  are  classified  under  the 
titles  of  asma,  dispnea,  orthomia,  hanelitus  and  sansugium.  The 
last  title  is  given  to  a  condition  in  which,  as  Gilbert  says,  "A  super- 
fluous humor  is  abundant  in  the  superficies  of  the  lung,  which  com- 
presses that  organ  and  renders  it  unable  to  dilate  in  inspiration. 
Hence  it  labors  in  inspiration  like  a  leech,  from  which  the  dyspnea 
derives  its  name." 

Under  the  single  title  of  "cardiaca  passio"  are  included  all  pos- 
sible diseases  of  the  heart.  The  symptoms  of  this  disease  are  said 
to  be  "palpitation,  twitching  of  the  limbs  (saltus  membrorum) ,  per- 
spiration, weakness  of  the  nerves,  facial  pallor,  weakness  of  the 
body  as  in  hectic  fever  or  phthisis,  excessive  pain  and  faintness 
over  the  precordia,  a  disposition  to  sleep  and  often  constipation. 
The  treatment  is,  of  course,  entirely  symptomatic. 

Diseases  of  the  digestive  apparatus  are  discussed  under  the 
headings  of  difficulties  of  deglutition,  canine  appetite,  bolismus 
(boulimia),  disturbances  of  thirst,  eructations,  hiccup,  nausea  and 
anorexia,  vomiting,  anathimiasis   (gastric  debility),  anatropha  and 

—  39  — 


GlLBERTUS    ANGLICUS 

catatropha  (varieties  of  obstinate  vomiting),  pain  in  the  stomach, 
abscess  of  the  stomach,  salivation,  colic,  dysentery  and  diarrhoea, 
intestinal  worms,  hemorrhoids,  rectal  tenesmus,  prolapsus  ani,  fistula 
in  ano,  diseases  of  the  liver,  dropsy,  jaundice  and  diseases  of  the 
spleen. 

Abscess  of  the  stomach  sometimes  manifests  a  circumscribed 
tumor,  and  accordingly,  probably  includes  cancer  of  that  organ. 
Approved  remedies  are  the  Al'mirabile,  the  stomatichon  frigidum, 
calidum  or  laxativumvum,  etc.,  stereotyped  formulae,  of  which  the 
composition  is  carefully  recorded. 

Dysentery  is  a  flux  of  the  bowels  with  a  sanguinolent  discharge 
and  excoriation  of  the  intestines.  A  variety  called  hepatic  dysen- 
tery, however,  lacks  the  intestinal  excoriation.  Diarrhoea  is  a  sim- 
ple flux  of  the  bowels,  without  either  the  sanguinolent  discharges 
or  the  intestinal  excoriation.  Lientery  is  a  flux  of  the  bowels  with 
the  discharge  of  undigested  food,  occasioned  by  irritability  (levitas) 
of  the  stomach  or  intestines.  Colical  passion  and  iliac  passion  de- 
rive their  names  from  the  supposed  origin  of  the  pain  in  the  colon 
or  ileum,  a  remark  which  furnishes  occasion  for  the  statement  that 
Gilbert  divides  the  bowels  into  six  sections,  viz.,  the  duodenum 
jejunum  and  ileum,  and  the  orobus,  colon  and  longaon  (rectum). 

Intestinal  worms  are  not  generated  in  the  stomach,  as  Gilbert 
says,  because  of  the  great  heat  produced  by  the  process  of  digestion. 
In  the  intestines  they  originate  chiefly  from  the  varieties  of  phlegm, 
e.g.,  saline,  sweet,  acid,  natural,  etc.  The  species  mentioned  spe- 
cifically are  lumbrici  and  ascarides  or  cucubitini,  though  the  terms 
long,  round,  short  and  broad  are  also  employed,  and  probably  in- 
clude the  tape  worm  or  taenia  lata.  The  treatment  of  these  parasites 
consists  generally  in  the  use  of  aromatic,  bitter  or  acid  mixtures, 
among  which  gentian,  serpentaria,  tithymal  and  cucumis  agrestis 
are  especially  commended  for  lumbrici,  and  enemata  of  wormwood, 
lupinus,  scammony,  salt,  aloes,  etc.,  for  ascarides. 

The  diseases  of  the  liver,  though  not  numerous,  are  allotted 
considerable  space  most  of  which  is  occupied  by  scholastic  specu- 
lations and  the  usual  rich  supply  of  therapeutical  suggestions. 

Discrasia  of  the  liver  has  several  varieties,  warm,  cold,  moist 
and  dry,  and  seems  nearly  equivalent  to  our  somewhat  overworked 
term  of  "biliousness."  Gilbert's  favorite  compounds  for  the  relief 
of  this  condition  are  the  Trifera  sarracenica,  the  Electuarium  psilli- 
ticum  and  above  all  the  Dyantos  Besonis. 

—  40  — 


GlLBERTUS    ANGLICUS 

Obstruction  (oppilatio)  of  the  liver  or  enfraxis  is  defined  as  a 
disease  of  the  canals  (pori),  of  which  four  are  enumerated,  to-wit, 
the  meseraic,  that  of  the  convexity  of  the  organ  (gibbus — ubi  sunt 
exitus  capillarium  venarum),  the  duct  leading  to  the  gall-bladder 
and  that  leading  to  the  spleen.  With  an  abundance  of  symptoms, 
it  is  singular  that  this  comprehensive  disease  does  not  seem  charac- 
terized by  any  constant  or  severe  pain,  as  we  might  reasonably 
expect. 

Abscess  of  the  liver  depends  upon  some  vice  of  the  blood,  the 
bile,  the  phlegm  or  the  black-bile.  The  general  treatment  is  poul- 
tices and  other  maturatives,  but,  as  the  author  adds  rather  sadly  at 
the  close,  ultima  cura  est  per  incisionem. 

Dropsy  is  discussed  as  an  independent  disease  through  the  ex- 
haustive speculations  of  thirty-two  pages.  Gilbert  tells  us  it  de- 
pends upon  some  fault  of  the  digestive  faculty  of  the  liver,  and  he 
divides  it  into  four  species,  to-wit,  leucoflantia,  yposarcha,  alchitis 
and  tympanitis,  each  of  which  has  its  special  and  appropriate  treat- 
ment. In  the  dreary  waste  of  speculative  discussion  it  is  cheering, 
however,  to  observe  Gilbert's  positive  recognition  of  the  sphere  of 
percussion  indicated  in  the  passage : 

"Et  venter  percussus  sonat  ad  modum  utris  semipleni  aqua  et 
venta,"     (f.  250b.) 

Ycteritia  or  jaundice  receives  equally  thorough  discussion 
through  eight  weary  pages,  including  the  usual  polypharmacal  treat- 
ment. 

The  spleen,  Gilbert  says,  is  sometimes  the  name  of  an  organ, 
sometimes  of  a  disease.  As  an  organ  it  is  spongy  and  loose  in  tex- 
ture, and  attracts  and  retains  the  superfluities  of  the  black-bile, 
expelled  from  the  liver  for  its  own  cleansing.  Hence  it  is  a  servile 
and  insensitive  organ,  and  accordingly  suffers  different  diseases, 
such  as  obstruction,  tumors,  hardening,  softening,  abscess,  and  some- 
times flatulence  or  repletion.  The  symptoms  and  treatment  of  each 
of  these  morbid  conditions,  arising  from  either  heat  or  cold,  are 
discussed  with  exasperating  thoroughness,  and  the  chapter  con- 
cludes with  the  composition  and  use  of  various  specific  remedies  of 
compound  character,  bearing  the  impressive  titles  of  Dyasene,  Dya- 
capparis,  Dyaceraseos  (a  mixture  of  cherry  juice,  honey,  cinnamon 
mastic  and  scammony)  and  Agrippa. 

Scrofulous  swellings  are  carefully  considered  in  a  chapter  en- 
titled "De  scrophulis  et  glandulis."    "Scrophulae  and  glandulae  are 

—  41  — 


GlLBERTUS    ANGL1CUS 

hard  swellings  developing  in  the  soft  parts,  as  in  the  emunctory  lo- 
calities of  the  veins  and  arteries,  particularly  in  the  neck,  armpits 
and  groins,  and  sometimes  in  other  places.  They  spring  from  the 
superfluities  of  the  principal  organs,  which  nature  expels,  as  it 
were,  to  the  emunctories  and  localities  designed  to  receive  this 
flux."  *  *  *  "Hence  they  are  often  found  the  cause  of  scabies, 
tinea,  malum  mortuum,  cancer,  fistula,  etc.,  and  are  called  glandes. 
Sometimes,  however,  a  dryer  matter  is  finely  divided  and  falls  into 
several  minute  portions,  from  which  arise  many  hard  and  globular 
swellings,  called  scrofulae  from  the  multiplicity  of  their  progeny, 
like  that  of  the  sow  (scrofa).  The  disease  is  also  called  morbus 
regius,  because  it  is  cured  by  kings." 

Gilbert  advises  that  these  swellings  should  not  be  "driven  in" 
(repercutienda) ,  but  brought  to  suppuration  generally  by  emollients 
and  poultices.  When  softened  they  may  be  opened  with  a  lancet 
and  the  pus  allowed  to  escape  gradually,  but  as  this  process  is  tedious, 
he  prefers  the  entire  removal  of  the  glands  with  the  knife,  pre- 
missing,  however,  that  no  gland  should  be  cut  into  which  cannot  be 
well  grasped  by  the  hand  and  pulled  from  its  seat.  This  surgical 
manipulation  is  fully  described,  and  is  undoubtedly  taken  from  the 
similar  chapter  of  Roger.  It  is  worthy  of  notice  also  that  just  at 
the  close  of  this  chapter,  Gilbert  mentions  a  swelling  called  "testudo," 
a  gland-like,  gaseous  (ventosa)  tumor,  usually  solitary  and  found 
in  "nervous"  localities,  like  the  joints  of  the  wrist  and  hand.  He 
says  it  often  occurs  from  fracture  {cassatura?)  of  the  nerves,  is 
cured  by  pressure,  friction  or  incision,  but  is  not  entirely  free  from 
danger.  Possibly  this  may  refer  to  ganglion.  Now,  Roger  makes 
no  mention  whatever  of  "testudo,"  while  Roland  says : 

"Nota  quod  quamvis  Rogerius  non  designat  inter  glandulum  et 
testudinem,  scias  igitur  quod  testudo  fit  ex  majori  parte  flegmatica, 
minori  melancholie,  glandula  vero  a  contrario,"  a  statement  which 
might  readily  suggest  the  suspicion  that  Gilbert  had  before  his  eyes 
the  text  of  Roland,  or  that,  at  least,  he  had  not  acquired  his  knowl- 
edge of  testudo  from  Roger,  his  usual  surgical  authority. 

Gilbert's  sections  on  goitre  (bocium  gulae)*  are  interesting  in 
themselves,  and  characteristic  of  the  method  adopted  by  him  in  his 
discussion  of  surgical  or  semi-surgical  subjects.  An  introduction 
relative  to  the  pathology  of  the  disease  and   which  seems   to  be 


*Cf.  the  French  bosse  de  la  gorge. 

—  42 


GlLBERTUS    ANGLICUS 

original,  is  followed  by  a  treatment,  medical  and  surgical,  adopted 
almost  literally  from  the  Chirurgia  of  Roger.  Thus  he  says : 
"Goiter  occurs  most  commonly  among  the  inhabitants  of  mountain- 
ous regions,  and  is  due  to  an  amplification  and  dilatation  of  the 
veins,  arteries  and  nerves,  together  with  the  soft  tissues,  occasioned 
by  the  north  wind  {ventum  boreale),  or  some  other  confined  wind, 
which  during  childhood  has  accumulated  in  (coadunabatur)  and 
enlarged  the  part  to  the  size  of  the  goiter."  After  suggesting  an 
analogy  between  the  disease  and  the  redness  and  turgidity  of  the 
neck  produced  by  passion  or  in  singing,  he  adds  that  some  cases  are 
due  to  an  accumulation  of  spongy  tissue  between  the  veins  and 
arteries,  or  to  the  use  of  flatulent  food,  and  he  even  tells  us  that 
some  old  women  know  how  to  produce  and  remove  goitrous  swell- 
ings by  means  of  certain  suitable  herbs  known  to  them. 

Under  medical  treatment  we  find  the  following:  "Dig  out  of 
the  ground  while  chanting  a  pater  noster,  a  nut  which  has  never 
borne  fruit.  The  roots  and  other  parts  pound  well  with  two  hundred 
grains  of  pepper,  and  boil  down  in  the  best  wine  until  reduced  in 
volume  to  one-half.  Let  the  patient  take  this  freely  on  an  empty 
stomach  until  cured." 

Another  more  elaborate  prescription  consists  of  a  long  list  of 
ingredients,  including  burnt  sponge,  saponaria,  the  milk  of  a  sow 
raising  her  first  litter,  with  numerous  simple  herbs,  and  the  sole 
object  for  which  this  nonsensical  farrago  is  introduced  here  is  to 
add  that  both  these  prescriptions  are  copied  from  the  surgery  of 
Roger.  It  is  important  too  to  remark  here  that  we  owe  to  Roger 
the  introduction  of  iodine,  under  the  form  of  burnt  sponge,  into  the 
treatment  of  goiter. 

In  the  failure  of  medical  treatment,  Gilbert  directs  the  em- 
ployment of  surgical  means,  e.g.,  the  use  of  setons,  or,  in  suitable 
cases,  extirpation  of  the  goiter  with  the  knife.  If,  however,  the 
tumor  is  very  vascular,  he  prefers  to  leave  the  case  to  nature  rather 
than  expose  the  patient  to  the  dangers  of  a  bloody  operation.  The 
whole  discussion  of  goiter  is  manifestly  a  paraphrase  of  the  similar 
chapter  of  Roger,  who  also  introduced  into  surgical  practice  the  use 
of  the  seton. 

In  Gilbert's  chapter  entitled  "De  arthretica  passione  et  ejus 
speciebus,"  we  are  introduced  to  the  earliest  discussion  by  an 
English  physician  of  that  preeminently  English  disease— gout.  We 
may  infer,  too,  from  the  length  of  the  discussion  (thirty  or  more 

—  43  — 


GlLBERTUS    ANGLICUS 

pages)  that  this  was  a  disease  with  which  Gilbert  was  not  only 
familiar,  but  upon  the  knowledge  of  which  he  prided  himself  greatly. 
Indeed,  it  is  one  of  the  few  diseases  of  the  Compendium  in  which 
the  author  assumes  the  position  of  a  clinician  and  introduces  ex- 
amples of  the  disease  and  its  treatment  taken  from  his  own  clientele. 
We  shall,  therefore,  follow  our  author  here  rather  more  carefully 
and  literally  than  usual,  that  we  may  learn  the  views  of  an  English 
physician  of  the  thirteenth  century  on,  perhaps,  the  most  charac- 
teristic disease  of  his  countrymen. 

Gilbert  says :  "Arthetica  is  a  disease  of  the  joints  arising  from 
a  flux  of  humors  descending  into  their  continuity  (concathena- 
tionem).  The  name  is  derived  from  the  Latin  artus,  a  joint,  and 
the  disease  comprehends  three  species,  viz.,  sciatica,  disease  of  the 
scia,  or  the  ligaments  uniting  the  spine  with  the  hip ;  cyragra,  dis- 
ease of  the  joints  of  the  hands;  and  podagra,  disease  of  the  bones 
and  joints  of  the  foot,  due  to  the  descent  of  humors  into  their  con- 
tinuity. Sometimes,  too,  the  disease  affects  other  organs,  occasion- 
ing pain  in  sensitive  members,  as,  e.g.,  the  head,  and  then  derives 
its  name  from  the  part  affected,  as  cephalea,  emigranea  or  mono- 
pagia.  Occasionally  likewise  some  humor  runs  down  (reumatizat) 
into  the  chest,  spreading  over  the  nerves  of  the  breast  or  those  of 
the  spine  between  the  vertebrae,  and  sometimes  to  other  places. 
Hence  the  disease  derives  the  general  name  gout  (gutta),  from  its 
resemblance  to  a  drop  (gutta)  trickling  or  falling  downward  and 
flowing  over  the  weaker  organs,  which  receive  the  humor.  For 
gout  arises  particularly  from  rheumatic  causes.  Now,  as  the 
humors  are  rather  uncontrollable  (male  terminabiles)  fluids,  they 
flow  towards  the  exterior  and  softer  parts,  like  the  flesh  and  skin, 
which  receive  their  moisture  and  being  soft,  dilatable  and  extensible, 
there  results  some  swelling.  But  if  the  humors  are  hard  and  dry, 
they  are  confined  within  the  interior  of  the  organs,  such  as  bones, 
nerves  and  membranes :  and  these,  being  hard  in  themselves,  do  not 
receive  the  moisture,  nor  suffer  extension  or  dilatation,  and  thus 
no  swelling  results.  Since,  therefore,  the  material  of  this  variety  of 
arthetica,  in  which  no  swelling  is  present,  is  formed  of  grosser  and 
harder  substance  and  is  found  in  the  vicinity  of  hard  and  cold 
localities,  it  is  dissolved  slowly  and  the  disease  is  not  cured  until  this 
solution  takes  place.  That  form  of  the  disease,  however,  in  which 
there  is  swelling  from  a  subtile  and  liquid  material  deposited  in  the 
soft  parts  is  the  more  quickly  cured.    Hence  swelling  is  the  best  sign 

—  44  — 


GlLBERTUS   ANGLICUS 

of  curability.  This  is  most  evidently  true  in  podagra,  unless  the 
materies  morbi,  by  reason  of  its  scarcity,  produces  no  enlargement 
of  the  affected  part." 

Quoting  the  words  of  Rhazes,  Gilbert  tells  us  that  the  materies 
morbi  of  gout  is,  for  the  most  part,  crude  and  bloody  phlegm. 
Rarely  is  it  bilious,  and  still  more  rarely,  melancholic.  If,  however, 
it  is  compounded,  it  consists  chiefly  of  bile  mixed  with  a  subtile 
phlegm,  and  more  rarely,  of  phlegm  mixed  with  black  bile  {melan- 
cholia), occasionally  of  black  bile  mixed  with  blood.  The  mixture 
of  black  bile  and  blood  or  bile  is  very  rare,  and  still  rarer  a  mixture 
of  all  the  humors  according  to  their  proportion  in  the  body. 

If  the  color  of  the  affected  part  is  red,  it  indicates  that  the 
materies  morbi  is  sanguineous;  if  greenish-yellow  (citrinus),  that 
it  is  bilious ;  if  whiter  than  the  general  color  of  the  body,  that  the 
materies  is  a  subtile  phlegm.  If  the  color  shades  away  into  black, 
it  does  not  signify  necessarily  that  the  materies  is  simply  black  bile, 
for  such  a  color  occurs  at  the  close  of  acute  abscesses,  or  from 
strangulation  of  the  blood.  But  if,  together  with  the  black  color, 
we  find  the  tissues  cold  and  no  increase  of  heat  in  the  affected  part, 
this  indicates  that  the  materies  is  black  bile. 

By  touching  the  diseased  part  we  determine  its  heat  or  cold- 
ness, hardness  or  softness,  roughness  or  smoothness,  fullness,  dis- 
tention or  evacuation,  all  of  which  signs  possess  special  significance. 

The  antecedent  causes  of  gout,  Gilbert  tells  us,  are  a  heat  too 
solvent,  cold  too  constringent  (f.  311  c),  sometimes  a  strong  bath 
or  a  severe  journey  in  a  plethoric  person  (in  plectorico),  again  ex- 
cessive coitus  after  a  full  meal  (satietatem) ,  or  even  habitual  excess, 
by  which  the  joints  are  weakened  and  deprived  of  their  natural  heat 
and  subtile  moisture.  Hence  boys  and  eunuchs  are  not  commonly 
affected  by  gout — at  least  boys  under  the  age  of  puberty.  Women, 
too,  do  not  usually  suffer  from  this  disease,  because  in  coitus  they 
are  passive,  unless  their  menstrual  discharge  is  suspended.  Again 
gout  sometimes  arises  from  infection  of  the  primary  semen;  for  a 
chronic  disease  may  be  inherited  by  the  offspring  and  affect  the 
material  causes,  i.e.,  the  humors.  Flatulence  (ventositas)  is  likewise 
a  cause  of  gout,  as  we  have  already  hinted. 

In  gout  of  the  sanguineous  type  the  favorite  remedy  of  Gilbert 
was  venesection,  pushed  to  extremes  which  suggest  the  bloody  theor- 
ies of  his  later  confrere  Bouillaud.  This  bloodletting,  however,  was 
always  to  be  practiced  on  the  side  opposite  to  that  affected  by  the 

—  45  — 


GlLBERTUS    ANGLICUS 

disease,  as  he  tells,  us,  for  two  reasons :  First  to  solicit  the  peccant 
material  to  the  opposite  side;  and,  second,  to  retard  its  course 
toward  the  seat  of  the  swelling.  If,  therefore,  the  disease  is  in  the 
right  foot,  he  bleeds  from  the  basilic  vein,  or  some  of  its  branches, 
in  the  right  hand.  No  other  vein  should  be  taken,  but  if  neither  the 
basilic  vein  nor  one  of  its  branches  can  be  found,  the  bleeding  may 
be  performed  upon  the  median  vein,  for  certain  branches  of  the 
basilic  and  cephalic  veins  unite  to  form  the  median.  If  the  disease 
is  in  the  hand,  the  material  may  be  diverted  in  two  ways,  either  to 
the  other  hand  or  to  the  opposite  foot.  Indeed,  blood  may  be  taken 
from  both  these  parts  in  succession.  The  quantity  of  blood  with- 
drawn should  be  in  accordance  with  the  strength  of  the  patient,  the 
character  of  the  swelling,  the  pulsation,  distention,  heat  and  redness 
of  the  affected  part.  But  it  should  be  repeated  frequently,  and  this 
bloodletting  then  frequently  suffices,  in  itself,  to  cure  the  disease. 

Gilbert  continues:  "I  will  tell  you  also  what  I  myself  saw  in  a 
woman  suffering  and  screaming  with  pain  in  her  right  wrist 
(assuere  ?),  which  was  greatly  swollen,  hot,  red  and  much  dis- 
tended. She  was  fat,  full-blooded,  and  before  the  attack  had  lived 
freely  on  milk  and  flesh.  Accordingly  she  was  robust,  and  I  bled 
her  from  the  basilic  vein  of  the  left  hand  and  the  saphena  of  the 
right  foot,  both  within  an  hour.  Each  hour  I  withdrew  a  half- 
pound  of  blood,  then  I  fed  her  and  for  three  hours  I  drew  half  a 
pound  of  blood  from  the  saphena.  In  the  last  hour  the  pain  and 
throbbing  (percussio)  ceased  entirely,  and  the  woman  begged  me 
to  bleed  her  again  from  the  hand,  for  she  had  experienced  great 
relief.  I  wished,  however,  to  divert  the  material  to  the  lower  ex- 
tremities for  two  reasons,  one  of  which  I  ought  not  to  mention  in 
this  place,  while  the  other  is  useful,  and  indeed  necessary  in  such 
cases.  You  should  know  that  this  woman  was  suffering  pain  in  her 
left  hand  also,  though  this  pain  was  of  a  less  severe  character  than  in 
the  right.  For  this  reason  I  desired  to  divert  the  peccant  matter 
downward,  a  point  which  the  physician  should  consider  and  observe. 
Once,  while  treating  a  man  suffering  from  sanguineous  gout,  the 
pain  of  which  involved  the  joints  between  the  assuerus  and  the 
racheta  (?)  of  the  right  hand,  I  asked  him  whether  any  pain  was 
felt  in  the  other  hand  or  in  the  feet.  He  replied  that  similar  pain 
was  felt  in  the  left  hand  or  its  joints,  and  that  hitherto  it  had  been 
more  severe,  but  that  no  pain  had  ever  been  experienced  in  the  feet. 
Hence  I  was  unwilling  to  bleed  him  at  all  from  the  left  hand,  but 

—  46  — 


Gilbert  us  Anglicus 

I  bled  him  from  the  right  foot.  A  physician  who  had  treated  him 
before,  and  had  bled  him  from  the  right  hand  for  acute  swelling 
of  the  joints  of  the  left,  quieted,  indeed,  the  pain  in  the  left  hand, 
but  diverted  the  disease  to  the  right,  where  a  swelling  developed 
larger  than  in  the  left.  And  when  I  asked  him  about  this,  he  under- 
stood that  I  knew  more  about  medicine  than  the  other  doctor  did. 
And  this  is  one  of  the  reasons  why  one  ought  to  divert  the  material 
to  another  part,  especially  when  the  pain  is  so  located  that  it  may 
be  increased  at  the  beginning.  For  under  such  conditions  we 
ought  to  refrain  from  bleeding,  frictions  and  other  treatment  which 
may  attract  the  materies  morbi  to  the  part.  Indeed  we  ought  to 
require  derivation  of  the  materies  to  another  part  whenever  the 
affected  locality  contains  one  of  the  nobler  organs,  towards  which 
the  material  is  directing,  or  may  direct  its  course.  For  instance : 
A  person  is  suffering  pain  in  the  joints  of  the  right  hand,  but  has 
also  an  acute  swelling  in  the  bladder,  the  kidneys  or  the  womb.  Now, 
I  say  that  in  such  a  case  we  ought  not  to  bleed  from  the  hand,  be- 
cause if  we  do  we  shall  injure  the  organ  affected  by  the  swelling. 
Perhaps,  however,  we  may  bleed  from  the  right  foot,  provided  we 
understand  that  there  is  on  the  right  side  a  sanguineous  tumor,  the 
danger  of  which  is  greater  than  that  of  the  swelling  on  the  right 
hand.  Again,  suppose  in  the  liver  or  in  the  right  kidney  an  acute 
tumor,  and  in  the  joints  of  the  right  hand  there  is  present  a  mod- 
erate pain.  I  say  that  we  ought  first  to  medicate  the  more  dangerous 
lesion,  and,  possibly,  two  results  may  be  obtained  by  the  attraction  of 
the  peccant  material.  Or  suppose  a  woman  has  gout  in  her  hand, 
and  with  this  a  suppression  of  the  menstrual  flow.  I  say  she  ought 
to  be  bled  from  the  foot  and  not  from  the  hand  for  two  objects,  to 
solicit  the  material  from  the  diseased  hand,  and  to  provoke  a  return 
of  the  menstrual  discharge. 

But  to  return  to  our  original  patient.  I  may  say  that  after  the 
third  venesection,  with  an  interval  of  two  hours,  I  withdrew  a  half- 
pound  of  blood  from  the  saphena  vein,  and  that  night  she  slept,  al- 
though she  had  not  slept  for  many  nights.  And  I  did  nothing  more, 
except  to  prescribe  a  light  and  cool  diet.  The  third  day  after  the 
bleeding  she  was  entirely  free  from  any  trouble  in  her  hand.  Hence 
I  say  that  we  ought  in  such  cases  to  begin  our  treatment  by  vene- 
section." 

After  this  sanguinary  introduction,  Gilbert  soothes  the  dis- 
eased part  with  cooling  and  astringent  ointments,  unless  these  occa- 

—  47  — 


GlLBERTUS   ANGLICUS 

sion  pain,  in  which  event  he  omits  them  entirely  and  trusts  the  case 
to  nature,  "quoniam  natura  per  se  curabit." 

The  vigorous  plan  of  treatment  thus  outlined  Gilbert  seems  to 
regard  as  original  and  peculiar  to  himself,  for  the  next  chapter 
bears  the  title,  "The  treatment  of  gout  according  to  the  authorities 
(secundum  magistros) ."  Here  he  says  he  quotes  the  opinions  of  the 
modern  teachers  and  writers,  who  lay  down  definite  rules  for  the 
guidance  of  the  physicians. 

Among  these  he  mentions,  as  primary  and  of  general  applica- 
tion, the  rule  that,  before  all  things,  the  body  must  be  purified,  either 
by  venesection  in  cases  where  the  material  is  sanguineous,  or  by 
purgation  in  other  varieties  of  the  disease.  If  the  cause  is  rheu- 
matic in  its  nature,  fomentations  should  never  be  employed,  for 
fear  of  increasing  the  flux.  That  the  peccant  material  is  to  be 
eliminated  gradually  by  mild  remedies,  just  as  it  accumulated  by 
degrees.  In  all  cases  of  gout,  and  in  all  chronic  diseases  generally, 
much  attention  must  be  devoted  to  the  stomach,  since  if  this  organ 
rejects  the  medicine,  the  latter  must  be  at  once  abandoned,  lest  the 
stomach  becomes  weakened  and  even  other  organs,  and  thus  the 
humors  flow  more  readily  (magis  reumatizarent)  to  the  joints,  etc. 

These  general  medical  rules  are  succeeded  by  some  twenty  pages 
devoted  largely  to  special  formulae  for  the  different  forms  of  gout, 
with  remarks  as  to  their  applicability  to  the  different  varieties  of 
the  disease.  Most  of  the  formulae  bear  special  titles,  apparently  to 
lend  the  weight  of  a  famous  name  to  the  virtues  of  the  prescription 
itself,  something  as  in  these  modern  days  we  speak  of  "Coxe's  Hive 
Syrup."  "Dover's  Powder,"  "Tully's  Powder,"  etc.  Thus  we  read 
of  the  "Pilulae  artheticae  Salcrnitorum,"  the  "Cathapcie  Alexan- 
drine," the  "Oxymel  Juliani"  the  "Pilulae  Arabice,"  the  "Pulvis 
Petrocelli,"  the  "Oleum  benediction,"  the  "Pilulae  Johannicii,"  etc. 
It  is  important,  too,  to  remark  that  the  active  ingredient  of  very 
many  of  these  formulae  is  the  root  called  hermodactyl,  believed  by 
the  majority  of  our  botanists  to  be  the  colchicum  autumnale. 

Gilbert's  discussion  of  gout  closes  with  a  short  and  characteris- 
tic chapter  entitled  "Emperica,"  in  which  he  remarks :  "Although  I 
perhaps  demean  myself  somewhat  in  making  any  reference  to  em- 
pirical remedies,  yet  it  is  well  to  write  them  in  a  new  book,  that  the 
work  may  not  be  lacking  in  what  the  ancients  (antiqui)  have  said 
on  the  subject.  Accordingly  I  quote  the  words  of  Torror.  If  you 
cut  off  the  foot  of  a  green  frog  and  bind  it  upon  the  foot  of  a  gouty 

—  48  — 


GlLBERTUS    ANGLICUS 

patient  for  three  days,  he  will  be  cured,  provided  you  place  the  right 
foot  of  the  frog  upon  the  right  foot  of  the  patient,  and  vice  versa. 
Funcius,  also,  who  wrote  a  book  on  stones,  said  that  if  a  magnet 
was  bound  upon  the  foot  of  a  gouty  patient,  he  is  cured.  Another 
philosopher  also  declared  that  if  you  take  the  heel-bone  of  an  ass 
and  bind  it  upon  the  foot  of  the  patient,  he  is  cured,  provided  that 
you  take  the  right  bone  for  the  right  foot,  and  conversely,  and  he 
swore  this  was  true.  Torror  also  said  that  if  the  right  foot  of  a 
turtle  is  placed  upon  the  right  foot  of  a  patient  suffering  from  the 
gout,  and  conversely,  he  will  be  cured." 

Gilbert's  discussion  of  leprosy  (De  lepra,  f.  336  d)  covers 
twenty  pages  and,  according  to  Sprengel,  is  "almost  the  first  correct 
description  of  this  disease  in  the  Christian  West."  Freind  says  this 
chapter  is  copied  chiefly  from  Theodorius  of  Cervia.  See  page  3 
ante.  If,  however,  I  am  correct  in  my  conjecture  that  the  Compen- 
dium was  written  about  the  year  1240,  the  copying  must  have  been 
done  by  Theodorius,  whose  "Chirurgia"  did  not  appear  until  1266. 

Leprosy  is  defined  as  a  malignant  disease  due  to  the  dispersion 
of  black  bile  throughout  the  whole  body,  corrupting  both  the  con- 
stitution (complexionem)  and  the  form  of  its  members.  Sometimes, 
too,  it  occasions  a  solution  of  continuity  and  the  loss  of  members. 

The  disease  is  sometimes  congenital,  arising  from  conception 
during  the  menstrual  period.  For  the  corrupt  blood  within  the  ma- 
ternal body,  which  forms  the  nourishment  of  the  fetus,  leads  like- 
wise to  the  corruption  of  the  latter.  Sometimes  the  disease  is  the 
result  of  a  corrupt  diet,  or  of  foul  air,  or  of  the  breath  or  aspect 
of  another  leper.  Avicenna  tells  us  that  eating  fish  and  milk  at  the 
same  meal  will  occasion  the  same  result.  Infected  pork  and  similar 
articles  of  diet  may  likewise  produce  the  disease.  Cohabitation  with 
a  woman  who  has  previously  had  commerce  with  a  leper  may  also 
produce  infection. 

Among  the  general  symptoms  of  leprosy  Gilbert  enumerates  a 
permanent  loss  of  sensation  proceeding  from  within  (iitscnsibilitas 
mansive  ad  intrinseco  veniens)  and  affecting  particularly  the  fingers 
and  toes,  more  especially  the  first  and  the  little  finger,  and  extending 
to  the  forearm,  the  arm  or  the  knees ;  coldness  and  formication  in 
the  affected  parts;  transparency  (luciditas)  of  the  skin,  with  the 
loss  of  its  natural  folds  (crispitudines) ,  and  a  look  as  if  tightly 
stretched  or  polished ;  distortion  of  the  joints  of  the  hands  and  feet, 
the  mouth  or  the  nose,  and  a  kind  of  tickling  sensation  as  if  some 

—  49  — 


GlLBERTUS   ANGLICUS 

living  thing  were  fluttering  within  the  body,  the  thorax,  the  arms 
or  the  lips.  There  is  felt  also  a  sensation  of  motion,  which  is  even 
visible  also  by  inspection.  Fetor  of  the  breath,  the  perspiration  and 
the  skin  are  likewise  noticeable.  The  localities  affected  lose  their 
natural  hair  and  are  re-covered  with  very  fine  hairs,  invisible  except 
when  held  between  the  eye  and  the  sun.  The  hair  of  the  eyebrows 
and  the  eyelashes  are  lost — one  of  the  worst  of  symptoms.  There 
are  present  also  hoarseness  and  an  obstruction  of  the  nostrils,  with- 
out any  visible  cause.  When  the  patient  takes  a  bath  the  water  runs 
off  the  affected  localities  as  if  they  had  been  greased — another  sign 
of  evil  omen.  The  angles  of  the  eyes  are  rounded  and  shining. 
The  skin,  even  when  unaffected  by  cold,  or  other  similar  cause,  is 
raised  into  very  minute  pimples,  like  the  skin  of  a  plucked  goose. 
The  blood  in  venesection  has  an  oily  appearance,  and  displays  small 
particles  like  sand.  Small  tumors  accompany  the  depilation  of  the 
eyebrows.  Lepers  are  unusually  and  unduly  devoted  to  sexual 
pleasures,  and  suffer  unusual  depression  after  sexual  indulgence. 
The  skin  is  tormented  with  a  constant  itching,  and  is  alternately 
unduly  hot  or  cold.  Small  grains  are  found  under  the  tongue,  as 
in  leprous  hogs. 

Gilbert  divides  leprosy  into  four  varieties,  elcphantia,  leonina, 
tyria  and  allopicia,  the  pathology,  symptoms  and  treatment  of  each 
of  which  are  presented  with  wearisome  minuteness  and  complete- 
ness. A  long  chapter,  entitled  "De  infectione  post  coitum  leprosi," 
discusses  the  transmission  of  the  disease  by  means  of  sexual  inter- 
course, and  suggests  the  possible  confusion  of  lepra  and  syphilis. 

The  usual  catalogue  of  specific  remedies  terminates  the  discus- 
sion. 

An  interesting  chapter  on  small-pox  and  measles.  "De  variolis 
et  morbillis,"  gives  us  the  prevailing  ideas  relative  to  these  diseases 
in  England  during  the  thirteenth  century.  Premising  his  remarks 
with  a  classification  of  diseases  as  follows : 

Diseases  universal  and  infectious — like  morphoea,  serpigo, 
lepra,  variolae  et  morbilli. 

Diseases  universal  but  not  infectious. 

Diseases  infectious  but  not  universal — like  noli  me  tangere. 

Diseases  neither  infectious  nor  universal. 


*It  is  at  least  interesting  to  know  that  small-pox  is  said  to  have  made 
its  first  appearance  in  England  in  1241. 

—  50  — 


GlLBERTUS    ANGLICUS 

Gilbert  classifies  variolae  et  morbilli  among  the  universal  and 
infectious  diseases,  and  in  the  species  apostemata.  To  this  latter 
species  belong  also  ignis  Persicus,  carbunculus  and  antrax. 

Variolae  et  morbilli  arise  from  moist  matter  confined  in  the 
body  and  turbid,  like  turbid  blood.  Hence  the  disease  occurs  most 
commonly  in  boys  and  in  those  who  are  careless  about  cleanliness 
and  neglect  venesection.  It  is  the  result  of  a  disposition  of  the  blood 
resembling  putrescence,  in  which  there  occurs  an  external  ebullition 
in  the  efforts  of  nature  to  purify  the  interior  of  the  body  and  to 
expel  to  the  surface  the  virulent  material  within.  Accordingly  the 
common  people  declare  that  persons  who  have  suffered  from 
variolae  et  morbilli  never  acquire  leprosy.  Occasionally,  too,  the 
disease  arises  from  excessive  corruption  of  matter  in  repletion  of 
blood,  and  hence  it  is  more  frequent  in  sanguineous  diseases,  like 
synocha,  and  during  the  prevalence  of  south  winds  or  the  shifting 
of  winds  to  the  south,  and  in  infancy — the  age  characterized  partic- 
ularly by  heat  and  moisture. 

The  eruptions  vary  in  color  in  accordance  with  the  mixture  of 
the  different  humors  with  the  corrupt  blood.  Hence  some  are  light 
colored,  some  the  color  of  saffron,  some  red,  some  green,  some  livid, 
some  black,  and  the  virulence  of  the  disease  is  the  greater,  the  nearer 
the  color  approaches  to  black.  There  are,  too,  four  varieties  of  the 
eruption,  distinguished  by  special  names.  When  the  eruption  is  light 
colored  and  tends  to  suppuration,  it  is  called  scora.  When  it  is  very 
fine  and  red,  it  is  called  morbilli  or  veterana.  The  distinction  be- 
tween variolae  and  morbilli  is  in  the  form  and  matter  of  the  disease, 
for  in  variolae  the  pustules  are  large  and  the  matter  bilious 
(colerica) ,  while  in  morbilli  the  eruption  is  smaller  and  does  not 
penetrate  the  skin  (non-pertransit  cutem).  Variolae,  on  the  con- 
trary, forms  a  prominent  pustule  (facit  eminentiam).  A  third 
form  of  the  disease  displays  only  four  or  five  large,  black  pustules 
on  the  whole  body,  and  this  form  is  the  most  dangerous,  since  it  is 
due  to  an  unnatural  black  bile,  or  to  acute  fevers,  in  which  the 
humors  are  consumed.  This  variety  bears  the  name  of  pustula.  A 
fourth  form  is  called  lenticula.  This  latter  form  occurs  sometimes 
with  fever,  like  synocha,  sometimes  without  fever,  and  it  arises  from 
pestilential  air  or  corrupt  food,  or  from  sitting  near  a  patient  suffer- 
ing from  the  disease,  the  exhalations  of  which  are  infectious. 

The  premonitory  symptoms  of  variolae  are  a  high  fever,  red- 

—  51  — 


GlLBERTUS    ANGLICUS 

ness  of  the  eyes,  pain  in  the  throat  and  chest,  cough,  itching  of  the 
nose,  sneezing  and  pricking  sensations  over  the  surface  of  the  body. 

Morbilli  is  a  mild  disease,  but  requires  protection  from  cold, 
which  confines  and  coagulates  the  peccant  matter. 

Attention  is  directed  to  the  not  infrequent  ulcers  of  the  eyes, 
which  occur  in  variolae  and  may  destroy  the  sight;  also  to  ulcera- 
tions of  the  nose,  throat,  oesophagus,  lungs  and  intestines,  the  latter 
of  which  often  produce  a  dangerous  diarrhoea. 

When  variolae  occurs  in  boys,  it  is  recommended  to  tie  the 
hands  of  the  patient  to  prevent  scratching. 

Whey  is  said  to  be  an  excellent  drink  for  developing  the  erup- 
tion of  variolae,  and  the  time-honored  saffron  {crocus)  appears  in 
several  of  Gilbert's  prescriptions  for  +his  disease.  Here,  too,  we  find 
the  earliest  mention  of  the  use  of  red  colors  in  the  treatment  of 
variolae  (f.  348  c)  : 

''Vetule  provinciales  dant  purpuram  combustam  in  potu,  habet 
enim  occultam  naturam  curandi  variolas.  Similiter  pannus  tinctus 
de  grano." 

Acid  and  saline  articles  of  food  should  be  avoided,  sweets  used 
freely,  and  the  patients  should  be  carefully  guarded  from  cold. 

Not  the  least  interesting  pages  of  the  Compendium  are  those 
(there  are  about  twenty  of  them)  devoted  to  the  discussion  of 
poisons,  poisoned  wounds  and  hydrophobia. 

An  introductory  chapter  on  the  general  subject  of  the  character 
of  poisonous  matters,  illustrated  by  some  gruesome  and  Munchausen- 
like  tales,  borrowed  mainly  from  Avicenna  and  Ruffus,  on  the  won- 
ders of  acquired  immunity  to  poisons,  the  horrors  of  the  basilisk,  the 
armaria  (?),  the  deaf  adder  (aspis  surda)  and  the  red-hot  regulus 
of  Nubia,  leads  naturally  to  the  consideration  of  some  special 
poisons  derived  from  the  three  kingdoms  of  nature.  Very  character- 
istically Gilbert  displays  his  caution  in  the  discussion  of  a  dangerous 
subject  by  the  following  preface: 

Abstineamus  a  venesis  occultis  quae  non  sunt  manifesta,  ne 
virus  in  angues  adjiciamus,  aut  doctrinam  perniciosam  tradere 
videamur  (f.  351  a). 

Beginning  then  with  metallic  mercury  (argentum  vivum),  he 
considers  the  poisonous  effects  of  various  salts  of  lead  and  copper, 
the  vegetable  poisons  hellebore,  anacardium  (anacardis  ?) ,  castor- 
eum,  opium  and  cassilago  (semina  hyoscyami) ,  and  then  proceeds 

—  52  — 


GlLBERTUS    ANGLIC! 

to  the  bites  or  rabid  men  and  animals,  hydrophobia,  and  the  bites  of 
scorpions,  serpents  and  the  animalia  annulosa,  that  is,  worms,  wasps, 
bees,  ants  and  spiders. 

Space  does  not  permit  a  careful  review  of  this  interesting  sub- 
ject, but  a  novel  form  of  poisoning  by  the  use  of  quicksilver  is 
startling  enough  to  claim  our  attention.  Gilbert  tells  us  that  pour- 
ing metallic  mercury  into  the  ear  produces  the  most  distressing  symp- 
toms, severe  pain,  delirium,  convulsions,  epilepsy,  apoplexy  and,  if 
the  metal  penetrates  to  the  brain,  ultimate  death.  In  the  treatment 
of  this  condition  certain  physicians  had  recommended  the  insertion 
into  the  ear  of  a  thin  lamina  of  lead,  upon  which  it  was  believed 
that  the  mercury  would  fasten  itself  and  might  thus  be  drawn  out. 
Avicenna  objected  to  this  that  the  mercury  was  liable  to  speedily 
pass  into  the  ear  so  deeply  as  to  be  beyond  the  reach  of  the  lead. 
Gilbert  suggests  as  an  improvement  of  the  treatment  that  a  thin 
lamina  of  gold  be  substituted  for  the  lead,  "because  mercury  thirsts 
after  gold  as  animals  do  after  water,  as  it  is  held  in  the  books  on 
alchemy"  (in  libris  allzinimicis) .  This  fact,  too,  he  tells  us  can  be 
easily  demonstrated  externally  by  placing  upon  a  plate  a  portion  of 
gold,  and  near,  but  not  in  contact  with  it,  a  little  quicksilver,  when 
the  silver,  he  says,  will  at  once  "leap"  upon  the  gold.  Avicenna 
suggests  that  the  patient  stand  upon  the  foot  of  the  side  affected, 
lean  his  head  over  to  the  same  side,  steady  it  in  that  position  with 
the  hands,  and  then  leap  suddenly  over  upon  the  other  foot — dem- 
onstrating thereby  his  knowledge  of  both  gravity  and  inertia.  Mani- 
festly our  "laboratory  physicians"  of  the  present  day  can  assume  no 
airs  of  priority! 

The  Compendium  closes  with  two  very  sensible  chapters  on  the 
hygiene  of  travel,  entitled  "De  regimine  iter  agentium"  and  "De 
regimine  trans fretantium." 

In  the  hygiene  of  travel  by  land  Gilbert  commends  a  preliminary 
catharsis,  frequent  bathing,  the  avoidance  of  repletion  of  all  kinds, 
an  abundance  of  sleep  and  careful  protection  from  the  extremes  of 
both  heat  and  cold.  The  strange  waters  may  be  corrected  by  a  dash 
of  vinegar.  Some  travelers,  he  tells  us,  carry  with  them  a  package 
of  their  native  soil,  a  few  grains  of  which  are  added  to  the  foreign 
waters,  as  a  matter  of  precaution,  before  drinking.  The  breakfast 
of  the  traveler  should  be  light,  and  a  short  period  of  rest  after  a 
day's  travel  should  precede  the  hearty  evening  meal.  Leavened 
bread  two  or  three  days  old  should  be  preferred.     Of  meats,  the 

—  53  — 


GlLBERTUS   ANGLICUS 

flesh  of  goats  or  swine,  particularly  the  feet  and  neighboring  parts, 
which,  Gilbert  tells  us,  the  French  call  gambones,  the  flesh  of  domes- 
tic fowls  and  of  the  game  fowls  whose  habitat  is  in  dry  places,  is  to 
be  preferred  to  that  of  ducks  and  geese.  Of  fish,  only  those  pro- 
vided with  scales  should  be  eaten,  and  all  forms  of  milk  should  be 
avoided,  except  whey,  "which  purifies  the  body  of  superfluities." 
Fruits  are  to  be  eschewed,  except  acid  pomegranates,  whose  juice 
cools  the  stomach  and  relieves  thirst.  Boiled  meats,  seasoned  with 
herbs  like  sage,  parsley,  mint,  saffron,  etc.,  are  better  than  roasted 
meats,  and  onion  and  garlic  are  to  be  avoided. 

The  primitive  conditions  of  land  travel  in  the  days  of  Gilbert 
are  emphasized  by  his  minute  directions  for  the  care  of  the  feet, 
which  he  directs  to  be  rubbed  briskly  with  salt  and  vinegar  and  then 
anointed  with  an  ointment  of  nettle-juice  (urtica)  and  mutton-fat, 
or  with  a  mixure  of  garlic,  soap  and  oil.  If  badly  swollen,  they 
should  be  bathed,  before  inunction,  with  a  decoction  of  elder-bark 
and  other  emollients. 

In  travel  by  sea,  Gilbert  tells  us  the  four  chief  indications  are 
to  prevent  nausea,  to  allay  vomiting,  to  palliate  the  foul  odor  of  the 
ship  and  to  quiet  thirst. 

For  the  prevention  of  nausea  he  recommends  the  juice  of  acid 
pomegranates,  lemons,  etc.,  or  a  decoction  of  parsley  or  sweet  cicely 
(cerfolium).  The  traveler  should  endeavor  to  sit  with  his  head 
erect,  should  avoid  looking  around,  but  maintain  his  head  as  immov- 
able as  possible,  and  support  himself  by  a  firm  grasp  upon  some 
beam  of  the  ship.  Some  sweets  may  be  sucked,  or  he  may  chew  a 
few  aromatic  seeds.  If  vomiting  ensues,  acid  or  sweet  pomegran- 
ates, figs  or  barley-sugar  (pcnides)  may  be  taken  sparingly,  but  no 
food  should  be  ingested  until  the  stomach  is  thoroughly  quieted. 
Then  the  patient  may  take  a  little  stoviatichon  or  dyantos,  and  a 
small  portion  of  digestible  food.  As  the  diet  must  necessarily  con- 
sist largely  of  salty  food  and  vegetables,  these  should  be  cooked  in 
three  or  four  different  waters,  and  then  soaked  in  fresh  water.  A 
little  aromatic  wine  will  also  benefit  the  patient,  and  a  few  aromatic 
seeds  chewed  in  the  morning  are  also  of  service. 

The  effect  of  the  foul  odors  of  the  ship  may  be  combatted  by 
the  use  of  aromatic  electuaries,  "which  comfort  the  heart,  the  brain 
and  the  stomach."  The  patient  should  be  removed  to  some  quiet 
portion  of  the  ship,  as  distant  as  possible  from  the  channels  for 
the  discharge  of  the  bilge-water,  and  short  walks  upon  the  upper 

—  54  — 


GlLBERTUS    ANGLICUS 

deck  will  contribute  to  convalescence.  Frequent  changes  of  cloth- 
ing will  palliate  the  annoyance  of  fleas  and  pediculi.  Drinking  water 
may  be  purified  by  aeration,  or  by  straining,  boiling  and  subsequent 
sedimentation  and  removal  of  the  sediment  by  filtration  through 
fresh  and  clean  sand.  For  the  wealthy,  the  water  may  be  distilled 
in  an  alembic,  if  such  an  apparatus  is  obtainable.  Avicenna  says 
that  bad  water  may  be  corrected  by  the  addition  of  vinegar.  Ex- 
posure to  the  midday  sun  and  to  the  nocturnal  cold,  constipation 
and  diarrhoea  should  be  avoided,  and  prompt  attention  should  be 
given  to  all  disorders  of  the  health. 

To  these  wise  counsels  Gilbert  courteously  adds  a  medieval  bon 
voyage  in  these  words : 

"Dominus  autem  omnia  dirigat  in  tranquilitate.     Amen." 

It  has  been  already  remarked  upon  a  preceding  page  that  Gil- 
bert of  England  was  not  a  surgeon.  Nevertheless  it  is  only  fair  to 
say  that  the  surgical  chapters  of  the  Compendium  present  a  more 
scientific  and  complete  view  of  surgical  art,  as  then  known,  than 
any  contemporaneous  writings  of  the  Christian  West,  outside  of 
Italy. 

It  is  well  known  that  during  the  Middle  Ages  the  practice  of 
surgery  in  western  Europe  was  generally  regarded  as  disreputable, 
and  operative  surgery  was  for  the  most  part  relegated  to  butchers, 
barbers,  bath-keepers,  executioners,  itinerant  herniotomists  and! 
oculists,  et  id  omne  genus,  whose  pernicious  activity  continued  to 
make  life  precarious  far  down  into  the  modern  period. 

In  Italy  alone  did  surgery  vindicate  for  itself  an  equality  with 
medicine,  and  the  pioneer  of  this  advance  was  Roger  of  Parma, 
who,  as  we  have  seen,  flourished  early  in  the  thirteenth  century. 
Roger  and  his  pupil  Roland,  with  the  somewhat  mythical  "Four 
Masters"  (Quatnor  Magistri),  were  the  surgical  representatives  of 
the  School  of  Saleraum,  while  Hugo  (Borgognoni)  di  Lucca  and 
his  more  famous  son  Theodorius  represented  the  rival  school  of 
Bologna.  Equally  famous  Italian  surgeons  of  this  century  were 
Bruno  of  Logoburgo  (in  Calabria)  and  Gulielmus  of  Saliceto 
(1275),  the  master  of  Lanfranchi  (1296).  Gilbert  of  England,  as 
a  pupil  of  Salernum,  naturally  followed  the  surgical  teachings  of 
that  school,  and  we  have  already  noticed  that  his  chapters  on 
surgery  are  taken  chiefly  from  the  writings  of  Roger  of 
Parma,    though    the    name    of    neither    Roger,    nor    indeed    of 

—  55  — 


GlLBERTUS    ANGLICUS 

any  other  distinctly  surgical  writer,  is  mentioned  in  the  Compen- 
dium. How  closely  in  some  cases  Gilbert  followed  his  masters 
may  best  be  seen  by  a  comparison  of  their  respective  chapters  upon 
the  same  subject.  I  accordingly  introduce  here  for  such  compari- 
son Roger's  chapter  on  wounds  of  the  neck,  and  the  corresponding 
chapter  of  Gilbert.     Roger  says: 

De  vulnere  quod  fit  in  cervice. 

Si  vero  cum  ense  vel  alio  simili  in  cervice  vulnus  fiat,  ita  quod 
vena  organica  incidatur,  sic  est  snbveniendum.  Vena  tota  suma- 
tur  (suatur)  cum  acu,  ita  quod  vena  non  perforetur,  et  ex  alia 
parte  acus  cum  filo  ei  inhaerente  ducatur,  et  cum  ipso  filo  nectatur 
atque  stringatur,  quod  sanguinem  non  emit  tat:  et  ita  facias  ex 
superiori  parte  et  inferiori.  In  vulnere  autem  pannus  infusus 
mittatur,  non  tamen  de  ipso  vulnus  multum  impleatur.  Embrocha, 
si  fucrit  in  myeme,  supcrponatur  quosque  (quousquc)  vulnus 
faciat  saniem.  Si  vero  fucrit  in  aestate  vitellus  avi  semper  super- 
ponatur.  Quum  autem  saniem  fecerit,  cum  panno  sicco, 
unguento  fusco  et  caeteris  bonam  carnem  generantibus,  adhibeatur 
cura,  ut  in  caeteris  vulncribus.  Quum  vero  extremitatem  venae 
superioris  partis  putruisse  cognoveris,  fila  praedicta  dissolvas,  et  a 
loco  illo  removeas:  et  deinde  procedas  ut  dictum  est  supcrius.  A.  Si 
vero  nervus  incidatur  in  longum  aut  ex  obliquo,  sed  non  ex  toto, 
hac  cura  potest  consolidari.  Terrestres  enim  vermes,  idest  qui  sub 
terra  nascuntur,  qui  in  longitudine  et  rotunditate  lumbricis  assimi- 
lantiir,  et  apud  quondam  terrestres  lumbrici  dicuntur,  accipiantur 
et  aliquantulum  conterantur  et  in  oleo  infusi  ad  igncm  calefiant:  et 
nullo  alio  mediante,  tcr  vel  quater,  vel  etiam  pluries,  si  opportunum 
videbis,  plagac  impone.  Si  vero  incidatur  ex  obliquo  totus,  minime 
consolidatur:  pracdicto  tamen  remedio  non  coadjuvante  saepe  con- 
glutinatur.  Potest  etiam  cuticula,  quae  supra  nervum  est,  sui, 
pulvisque  rubens,  qui  jam  dictus  est,  superaspergi,  quae  cura  non 
est  inutilis,  aliquos  enim  non  solum  conglutinatas,  sed  etiam  con- 
solidatas,  nostra  cura  prospeximus.  Si  vero  locus  tumet,  em- 
brocham  Mam,  quam  in  prima  particula  ad  tumorem  removendum, 
qui  ex  percussura  contigit,  praediximus,  ponatur,  quousque  talis 
tumor  recesserit." 

Gilbert,  after  premising  two  short  chapters  entitled  "De  vul- 
neribus  colli"  and  "De  perforatione  colli  ex  utraque  parte,"  con- 
tinues as  follows: 

—  56  — 


GlLBERTUS    ANGLICUS 

De  vena  organic  a  incisa. 
Si  vena  organica  in  cervice  incidatur :  tota  vena  suatur  cum  acu, 
ita  quod  vena  non  perforetur,  et  ux  alia  parte  acus  cum  filo  ei  adhe- 
rente  ita  nectatur  at  que  stringatur  quod  (non)  emit  tat  sanguinem,  et 
ita  fiat  ex  superiori  parte  et  inferiore  vene.  In  vulnere  autem  pannus 
infusus  in  albumine  ovi  mittatur,  nee  tamen  de  ipso  panno  vulnus 
multum  impleatur.  Embroca  vero  superius  dicta,  si  in  hyeme  fuerit, 
superponatur,  donee  vulnus  saniem  emit  tat.  Si  vere  in  estate, 
vitellum  ovi  turn  super  ponatur,  et  cum  saniem  fecerit,  panno  sicco, 
et  unguento  fusco  et  ceteris  regenerantibus  carnem,  curetur.  Cum 
vero  extremitatem  vene  superioris  et  inferioris  putruisse  cognoveris, 
fila  dissolvantur  et  a  loco  removeantur,  et  deinde  ut  dictum  est 
procedatur. 

De  incisione  nervi  secundum  longum  aut  secundum  obliquum. 

Si  vero  secundum  longum  aut  obliquum  vervi  incidantur,  et  non 
ex  toto,  ita  consolidamus.  Terrestres  vermes,  qui  sub  terra  nas- 
cuntur,  similes  in  longitudine  et  rotunditate  lumbricis,  qui  etaim 
lumbrici  terre  appellantur:  hi  aliquantulum  contcrantur  et  in  oleo 
infusi  ad  ignem  calefiant,  et  nullo  aliomediante,  ter  vel  quater  vel 
pluries,  si  opportunum  fuerit,  plagelle  impone.  Si  vero  ex  oblique 
nervus  incidatur,  eodem  remedio  curatur,  et  natura  cooperante  saepe 
conglutinatur.  Potest  quoque  cuticula  quae  supra  nervum  est  sui, 
et  pulvis  ruber  superaspergatur.  Nervos  enim  conglutinari  et  con- 
solidari  hoc  modo  sepius  videmus.  Si  vero  locus  tumeat,  embroca, 
praedicta  in  vidnere  capitis  quae  prima  est  ad  tumorem  removendum, 
superponatur,  quousque  tumor  recesserit.  Si  vena  organica  non 
inciditur,  pannus  albumine  ovi  infusus  in  vulnere  ponatur.  Em- 
broca vero  post  de  superponatur  (f.  179  c). 

The  selection  and  collection  of  words  and  phrases  in  these  two 
passages  leaves  little  doubt  that  one  was  copied  from  the  other. 
Indeed,  so  close  is  their  resemblance  that  it  is  quite  possible  from 
the  one  text  to  secure  the  emendation  of  the  other.  Numerous 
similar  passages,  with  others  in  which  the  text  of  Gilbert  is  rather  a 
paraphrase  than  a  copy  of  the  text  of  Roger,  serve  to  confirm  the 
conclusion  that  the  surgical  writings  of  the  English  physician  are 
borrowed  mainly  from  the  "Chirurgia"  of  the  Italian  surgeon. 
Some  few  surgical  chapters  of  the  Compendium  appear  to  be 
either  original  or  borrowed  from  some  other  authority,  but  their 
number  is  not  sufficient  to  disturb  the  conclusion  at  which  we  have 

—  57  — 


GlLBERTUS   ANGLICUS 

already  arrived.  Now,  as  Roger's  "Chirurgia"  was  probably  com- 
mitted to  writing  in  the  year  1230,  when  the  surgeon  was  an  old 
man,  these  facts  lead  us  to  the  conclusion  that  Gilbert  must  have 
written  his  Compendium  at  least  after  the  date  mentioned. 

Another  criticism  of  these  chapters  suggests  certain  interesting 
chronological  data.  It  will  be  observed  that  Roger,  in  the  passage 
quoted  above,  recommends  a  dressing  of  egg-albumen  for  wounds 
of  the  neck,  and  expresses  considerable  doubt  whether  nerves,  when 
totally  divided,  can  be  regenerated  (consolidari) ,  though  they  may 
undoubtedly  be  reunited  (conglutinari). 

Now  Roland,  in  his  edition  of  Roger's  "Chirurgia,"  criticises 
both  of  these  statements  of  his  master,  as  follows : 

Nota  quod  quamvis  Rogerius  dicat  quod  apponatur  albumen 
ovi,  non  approbo,  quia  frigidum  est  naturaliter,  et  vena  et  nervus  et 
arteria  frigida  sunt  naturaliter,  et  propter  frigiditatem  utr  or  unique 
non  potest  perfecte  fieri  consolidatio. 

And  again : 

Nota  quod  secundum  Rogcrium  nervus  omnino  incisus  non 
potest  consolidari,  vel  conjungi  nee  sui.  Nos  autcm  dicimus  quod 
potest  consolidari  et  iterum  ad  viotum  reddi  habillis,  cum  hac 
cautela:  Cautcrizctur  utrumque  caput  nervi  incisi  peroptime  cum 
ferro  candenti,  sed  cave  vulncris  lobia  cum  ferro  calido  tangantur. 
Deindc  apponantur  vermes  contusi  et  pulvcrcs  consolidativi,  etc. 

It  will  be  observed  that  Gilbert,  in  spite  of  the  rejection  by 
Roland  of  the  egg-albumen  dressing  of  Roger,  still  recommends  its 
use  in  wounds  of  the  neck,  and  although  he  professes  to  have  seen 
many  nerves  regenerated  (consolidari)  under  the  simple  angle- 
worm treatment  of  his  master,  he  still  makes  no  mention  of  the 
painful  treatment  of  divided  nerves  by  the  actual  cautery,  so  highly 
praised  by  Roland.  It  would  seem,  therefore,  that  Gilbert  was  not 
familiar  with  the  writings  of  Roland  when  his  Compendium  was 
written,  or  he  would,  doubtless,  not  have  omitted  so  peculiar  a  plan 
of  treatment  in  an  injury  of  such  gravity.  As  Roland's  edition  of 
Roger's  "Chirurgia"  is  said  to  have  been  written  in  1264,  the  com- 
parison of  these  passages  would  seem  to  indicate  that  Gilbert  must 
have  written  the  Compendium  after  1230  and  prior  to  the  year  1264. 

Gilbert's  surgical  chapters  discuss  the  general  treatment  of 
wounds  and  their  complications,  and  more  specifically  that  of 
wounds    of    the   head,    neck,    throat,    wounds    of    nerves,    of    the 

—  58  — 


GlLBERTUS   ANGLICUS 

oesophagus,  scapula,  clavicle,  of  the  arm,  the  stomach,  intestines 
and  the  spleen;  fractures  of  the  clavicle,  arm,  forearm  and  ribs; 
compound  fractures;  dislocations  of  the  atlas,  jaw,  shoulder  and 
elbows;  fistulae  in  various  localities,  and  the  operations  on  the 
tonsils  and  uvula,  on  goitre,  hernia  and  stone  in  the  bladder,  etc. — 
certainly  a  surgical  compendium  of  no  despicable  comprehensive- 
ness for  a  physician  of  his  age  and  country. 

In  the  general  treatment  of  wounds  (f.  86  c)  Gilbert  tells  us 
the  surgeon  must  consider  the  time,  the  age  of  the  patient,  his  tem- 
perament (complcxio)  and  the  locality,  and  be  prepared  to  temper 
the  hot  with  the  cold  and  the  dry  with  the  moist.  Measures  for 
healing,  cleansing  and  consolidation  are  required  in  all  wounds,  and 
these  objects  may,  not  infrequently,  be  accomplished  by  a  single 
agent.  The  general  dressing  of  most  wounds  is  a  piece  of  linen 
moistened  with  the  white  of  egg  (pecia  panni  in  albumine  ov'x 
infusa),  and,  as  a  rule,  the  primary  dressing  should  not  be  changed 
for  two  days  in  summer,  and  for  three  days  in  the  winter.  In  moist 
wounds  vitreolum  reduces  the  flesh;  in  dry  wounds  it  repairs  and 
consolidates.  Flos  aeris,  in  dry  wounds,  reduces  but  does  not  con- 
solidate, but  rather  corrodes  the  tissues.  Excessive  suppuration  is 
sometimes  the  result  of  too  stimulating  applications,  sometimes  of 
those  which  are  too  weak.  In  the  former  case  the  wound  enlarges, 
assumes  a  concave  form,  is  red,  hot,  hard  and  painful,  and  the  pus 
is  thin  and  watery  (subtilis).  If  the  application  is  too  weak,  the 
pus  is  thick  and  viscous,  and  the  other  signs  mentioned  are  wanting. 
In  either  case  the  dressings  are  to  be  reversed.  If  any  dyscrasia, 
such  as  excessive  heat,  coldness,  dryness  or  moisture  appears  in 
the  wound  and  delays  its  healing,  it  is  to  be  met  by  its  contrary. 
If  fistula  or  cancer  develops,  this  complication  is  to  be  first  cured 
and  then  the  primary  wound.  The  signs  of  a  hot  dyscrasia  are  heat, 
burning  and  pain  in  the  wound ;  of  a  cold  dyscrasia,  lividity  of  the 
wound;  the  moist  dyscrasia  occasions  flabbiness  (mollicies)  and 
profuse  suppuration,  and  the  dry  produces  dryness  and  induration. 

Wounds  of  the  head  (f.  84c)  occur  with  or  without  fracture 
of  the  cranium,  but  always  require  careful  examination  and  exact 
diagnosis.  The  wound  is  to  be  carefully  explored  with  the  finger, 
and,  if  necessary,  should  be  enlarged  for  this  purpose.  Large,  but 
simple,  wounds  of  the  scalp  should  be  stitched  with  silk  in  three  or 
four  places,  leaving  the  most  dependent  angle  open  for  escape  of 
the  discharges,  and  in  this  opening  should  be  inserted  a  tent  (tuellus), 

—  59  — 


GlLBERTUS    ANGLICUS 

lO  facilitate  drainage.  The  wound  is  then  sprinkled  with  the  pulvis 
rubeus  and  covered  with  a  plantain  or  other  leaf.  On  the  ninth  to 
the  eleventh  day,  if  the  wound  seems  practically  healed,  the  stitches 
are  to  be  removed  and  the  cure  completed  with  simple  dressings. 

The  signs  and  symptoms  of  fracture  of  the  cranium  are :  Loss 
of  appetite  and  failure  of  digestion,  insomnia,  difficulty  in  micturi- 
tion, constipation,  a  febrile  dyscrasia,  difficulty  in  cracking  nuts  or 
crusts  of  bread  with  the  jaws,  or  severe  pain  when  a  string  is  at- 
tached to  the  teeth  and  pulled  sharply.  If  the  meninges  are  injured 
we  have  further:  headache,  a  slow  arid  irregular  but  increasing 
fever,  alternating  with  chills,  distortion  of  the  angles  of  the  eyes, 
redness  of  the  cheeks,  mental  disturbances,  dimness  of  vision,  a 
weak  voice  and  bleeding  from  the  ears  or  the  nose.  In  the  presence 
of  such  symptoms  the  death  of  the  patient  may  be  expected  within 
at  most  a  hundred  days. 

If  the  fracture  of  the  cranium  is  accompanied  by  a  large  scalp 
wound,  any  fragments  of  bone  or  other  foreign  body  are  to  be  ex- 
tracted at  once,  unless  haemorrhage  or  the  weakness  of  the  patient 
are  feared,  and  then  a  piece  of  linen  is  to  be  cautiously  worked  in 
with  a  feather  between  the  cranium  and  the  dura  mater.  In  the 
fracture  itself  a  piece  of  linen,  or  better  of  silk,  is  inserted,  the 
apparent  purpose  of  this  double  dressing  being  to  protect  the  dura 
mater  from  the  discharges  and  to  solicit  their  flow  to  the  exterior. 
A  piece  of  sponge,  carefully  washed,  dried  and  placed  in  the  wound, 
Gilbert  tells  us,  absorbs  the  discharges  satisfactorily  and  prevents 
their  penetration  internally.  Over  the  wound  is  placed  a  bit  of  linen 
moistened  with  egg-albumen,  then  a  dressing  of  lint,  and  the  whole 
is  maintained  in  place  by  a  suitable  bandage.  Finally  the  patient  is 
to  be  laid  in  bed  and  maintained  in  such  a  position  that  the  wound 
will  be  dependent,  so  as  to  favor  the  ready  escape  of  the  discharges. 
This  dressing  is  to  be  renewed  three  times  a  day  in  summer,  and 
twice  in  winter.  Proud  flesh  upon  the  dura  mater  is  to  be  re- 
pressed by  the  application  of  a  sponge,  well-washed  and  dried,  and 
if  it  appears  upon  the  surface  of  the  wound  after  the  healing  of  the 
fracture,  it  is  to  be  destroyed  by  the  use  of  the  hermodactyl.  When 
the  external  wound  is  healed,  the  cicatrix  is  to  be  dressed  with  the 
apostolicon  cyrurgicum,  an  ointment  very  valuable  for  the  consoli- 
dation of  bones,  the  leveling  (adaequatiof)  of  wounds,  etc. 

When  the  wound  of  the  scalp  is  small,  so  as  to  render  difficult 
the  determination  of  the  extent  of  the  fracture  by  exploration  with 

—  60  — 


GlLBERTUS    ANGLICUS 

the  finger,  it  should  be  enlarged  by  crucial  incisions,  the  flaps  loos- 
ened from  the  cranium  by  a  suitable  scraper  (rugine)  and  folded 
back  out  of  the  way,  and  any  fragments  of  bone  removed  by  the 
forceps  (pinceolis).  If,  however,  haemorrhage  prevents  the  im- 
mediate removal  of  the  fragments,  this  interference  may  be  deferred 
for  a  day  or  two,  until  the  bleeding  has  stopped  or  has  been  checked 
by  suitable  remedies.  Then,  after  their  removal,  the  piece  of  linen 
described  above  is  to  be  inserted  between  the  cranium  and  dura 
mater.  Upon  the  cranium  and  over  the  flaps  of  the  scalp,  as  well 
as  in  their  angles,  the  ordinary  dressing  of  albumen  is  to  be  applied, 
covered  by  a  pledget  of  lint  and  a  suitable  bandage.  No  ointment, 
nor  anything  greasy,  should  be  applied  until  after  the  healing  of  the 
wound,  lest  some  of  it  may  accidentally  run  down  into  the  fracture 
and  irritate  the  dura  matter.  Some  surgeons,  Gilbert  tells  us,  insert 
in  the  place  of  the  fragments  of  the  cranium  removed  a  piece  of  a 
cup  (ciphi)  or  bowl  {mazer),  or  a  plate  of  gold,  but  this  plan,  he 
says,  has  been  generally  abandoned  (dimittitur .) 

Sometimes  the  cranium  is  simply  cracked  without  any  depres- 
sion of  the  bone,  and  such  fractures  are  not  easily  detected.  Gilbert 
tells  us,  however,  that  if  the  patient  will  close  firmly  his  mouth  and 
nose  and  blow  hard,  the  escape  of  air  through  the  fissured  bone  will 
reveal  the  presence  of  the  fracture  (f.  88a).  In  the  treatment  of 
such  fissures  he  directs  that  the  scalp  wound  be  enlarged,  the  cranium 
perforated  very  cautiously  with  a  trepan  (trepano)zt  each  extremity 
of  the  fissure  and  the  two  openings  then  connected  by  a  chisel 
{spataf),  in  order  to  enable  the  surgeon  to  remove  the  discharges 
by  a  delicate  bit  of  silk  or  linen  introduced  with  a  feather.  If  a  por- 
tion of  the  cranium  is  depressed  so  that  it  cannot  be  easily  raised 
into  position,  suitable  openings  are  to  be  made  through  the  depressed 
bone  in  order  to  facilitate  the  free  escape  of  the  discharges. 

Gunshot  wounds  were,  of  course,  unknown  in  Gilbert's  day. 
In  a  chapter  entitled  "De  craneo  perforato"  he  gives  us,  however, 
the  treatment  of  wounds  of  the  head  produced  by  the  transfixion  of 
that  member  by  an  arrow.  If  the  arrow  passes  entirely  through  the 
head,  and  the  results  are  not  immediately  fatal,  he  directs  the  sur- 
geon to  enlarge  the  wound  of  exit  with  a  trephine,  remove  the  arrow- 
head through  this  opening,  and  withdraw  the  shaft  of  the  arrow 
through  the  wound  of  entrance.  The  wounds  of  the  cranium  are 
then  to  be  treated  like  ordinary  fractures  of  that  organ  (f.  88c). 

In  wounds  of  the  neck  involving  the  jugular  vein  {vena  organ- 

—  61  — 


GlLBERTUS   ANGLICUS 

tea),  Gilbert  directs  ligation  of  both  extremities  of  the  wounded 
vessel,  after  which  the  wound  is  to  be  dressed  (but  not  packed) 
with  the  ordinary  dressing  of  egg- albumen. 

Wounds  of  nerves  are  treated  with  a  novel  dressing  of  earth- 
worms lightly  beaten  in  a  mortar  and  mixed  with  warm  oil,  and  he 
professes  to  have  seen  nerves  not  only  healed  (conglutinari) ,  but 
even  the  divided  nerve  fibres  regenerated  (consolidari)  under  this 
treatment.  In  puncture  of  a  nerve  Gilbert  surprises  us  (f.  179d) 
by  the  advice  to  divide  completely  the  wounded  nerve,  in  order  to 
relieve  pain  and  prevent  tetanus  (spasmus) . 

Goitre,  not  too  vascular  in  character,  is  removed  by  a  longi- 
tudinal incision  over  the  tumor,  after  which  the  gland  is  to  be 
dragged  out,  with  its  entire  capsule,  by  means  of  a  blunt  hook.  A 
large  goitre  in  a  feeble  patient,  however,  is  better  left  alone,  as  it  is 
difficult  to  remove  all  the  intricate  roots  of  the  tumor,  and  if  any 
portion  is  left  it  is  prone  to  return.  In  such  cases  Gilbert  says  we 
shrink  from  the  application  of  the  actual  cautery,  for  fear  of  injury 
to  the  surrounding  vessels  and  nerves.  Whatever  method  of  opera- 
tion is  selected,  the  patient  is  to  be  tied  to  a  table  and  firmly  held  in 
position. 

Wounds  of  the  trachea  and  oesophagus,  according  to  Gilbert, 
are  invariably  mortal. 

In  wounds  of  the  thorax  the  ordinary  dressing  of  albumen  is  to 
be  applied,  but  if  blood  or  pus  enters  the  cavity  of  the  thorax,  the 
patient  is  directed  to  bend  his  body  over  a  dish,  twisting  himself 
from  one  side  to  another  (supra  discum*  flectat  se  modo  hac  modo 
ilac  vergendo)  until  he  expels  the  sanies  through  the  wound,  and  to 
always  lie  with  the  wound  dependent  until  it  is  completely  healed 
(f.  182d). 

In  case  an  arrow  is  lodged  within  the  cavity  of  the  thorax,  the 
surgeon  is  directed  to  trepan  the  sternum  (os  pectoris),  remove  the 
head  of  the  arrow  gently  from  the  shaft,  and  withdraw  the  shaft 
itself  through  the  original  wound  of  entrance.  If  the  head  is  lodged 
beneath  or  between  the  ribs,  an  opening  is  to  be  made  into  the  near- 
est intercostal  space,  the  ribs  forced  apart  by  a  suitable  wedge  and 
the  head  thus  extracted.     The  wound  through  the  soft  parts  is  to 


It  is  interesting  to  observe  how  the  Latin  discus  developed  dichotomouslv 
into  the  English  "dish"  and  the  German  "Tisch."  The  former  is  doubtless 
the  meaning  of  the  word  in  this  place. 

—  62  — 


GlLBERTUS    ANGLICUS 

be  kept  open  by  a  tent  greased  with  lard  and  provided  with  a  suitable 
prolongation  (cauda  aliqua)  to  facilitate  its  extraction  and  prevent 
its  falling  into  the  cavity  of  the  chest. 

Wounds  of  the  heart,  lungs,  liver,  stomach  and  diaphragm  are 
regarded  as  hopelessly  mortal  (  f .  233d),  and  the  physician  is  advised 
to  have  nothing  to  do  with  them.  Wounds  of  the  heart  are  recog- 
nized by  the  profuse  haemorrhage  and  the  black  color  of  the  blood ; 
those  of  the  lung  by  the  foamy  character  of  the  blood  and  the 
dyspnoea;  wounds  of  the  diaphragm  occasion  similar  dyspnoea  and 
are  speedily  fatal ;  those  of  the  liver  are  known  by  the  disturbance 
of  the  hepatic  functions,  and  wounds  of  the  stomach  by  the  escape 
of  its  contents.  Wounds  of  the  intestine  are  either  incurable,  or 
at  least  are  cured  only  with  the  utmost  difficulty.  Longitudinal 
wounds  of  the  spine  which  do  not  penetrate  the  cord  may  be  repaired, 
but  transverse  wounds  involving  the  cord,  so  that  the  latter  escapes 
from  the  wound,  are  rarely,  if  ever,  cured  by  surgery.  Wounds  of 
the  kidneys  are  also  beyond  the  art  of  the  surgeon.  Wounds  of  the 
penis  are  curable,  and  if  the  wound  is  transverse  and  divides  the 
nerve,  they  are  likewise  painless. 

Si  vene  titillares  in  coxis  abscidantur  homo  moritur  ridendo. 
A  passage  which  I  can  refer  only  to  the  erudition  and  risibility  of 
our  modern  surgeons  and  anatomists.  The  ticklish  vene  titillares 
are  to  me  entirely  unknown. 

Modern  abdominal  surgeons  will  probably  be  interested  in  read- 
ing Gilbert's  chapter  on  the  treatment  of  wounds  of  the  intestines  in 
the  thirteenth  century.     He  says  (f.  234c)  : 

If  some  portion  of  the  intestine  has  escaped  from  a  wound  of  the 
abdomen  and  is  cut  either  longitudinally  or  transversely,  while  the 
major  portion  remains  uninjured;  if  the  wound  has  existed  for 
some  time  and  the  exposed  intestine  is  cold,  some  living  animal,  like 
a  puppy  (catulus),  is  to  be  killed,  split  longitudinally  and  placed  over 
the  intestine,  until  the  latter  is  warmed,  vivified  by  the  natural  heat 
and  softened.  Then  a  small  tube  of  alder  is  prepared,  an  inch  longer 
than  the  wound  of  the  intestine,  carefully  thinned  down  (subtilietur) 
and  introduced  into  the  gut  through  the  wound  and  stitched  in  posi- 
tion with  a  very  fine  square-pointed  needle,  threaded  with  silk. 
This  tube  or  canula  should  be  so  placed  as  to  readily  transmit  the 
contents  of  the  intestine,  and  yet  form  no  impediment  to  the  stitches 
of  the  wound.  W'hen  this  has  been  done,  a  sponge  moistened  in 
warm  water  and  well  washed  should  be  employed  to  gently  cleanse 

—  63  — 


Gilbert  us  Anglicus 

the  intestines  from  all  foreign  matters,  and  the  gut,  thus  cleansed, 
is  to  be  returned  to  the  abdominal  cavity  through  the  wound  of  the 
abdominal  wall.  The  patient  is  then  to  be  laid  upon  a  table  and 
gently  shaken,  in  order  that  the  intestines  may  resume  their  normal 
position  in  the  abdomen.  If  necessary  the  primary  wound  should 
be  enlarged  for  this  purpose.  When  the  intestines  have  been  thus 
replaced,  the  wound  in  the  abdominal  wall  is  to  be  kept  open  until 
the  wound  of  the  intestine  seems  healed.  Over  the  intestinal  suture 
a  little  piilvis  ruber  should  be  sprinkled  every  day,  and  when  the 
wound  of  the  intestine  is  entirely  healed  {consolidatur),  the  wound 
of  the  abdominal  wall  is  to  be  sewed  up  and  treated  in  the  manner 
of  ordinary  flesh  wounds. 

If,  however,  the  wound  is  large,  a  pledget  (pecia)  of  lint,  long 
enough  to  extend  from  one  end  to  the  other  and  project  a  little,  is 
placed  in  the  wound,  and  over  this  the  exterior  portion  of  the 
wound  is  to  be  carefully  sewed,  and  sprinkled  daily  with  the  pulvis 
ruber.  Every  day  the  pledget  which  remains  in  the  wound  is  to  be 
drawn  towards  the  most  dependent  part,  so  that  the  dressing  in  the 
wound  may  be  daily  renewed.  When  the  intestinal  wound  is  found 
to  be  healed,  the  entire  pledget  is  to  be  removed  and  the  unhealed 
openings  dressed  as  in  other  simple  wounds.  The  diet  of  the  patient 
should  be  also  of  the  most  digestible  sort. 

Thus  far  Gilbert  has  followed  Roger  almost  literally.  Rut  he 
now  adds,  apparently  upon  his  own  responsibility,  the  following 
paragraph : 

Quod  si  placuerit,  extrahe  canellum  :  factis  punctis  in  sutura 
ubi  debent  fieri  antequan  stringantur,  inter  duo  puncta  canellus 
extrahatur,  et  post  puncta  stringantur.  Hoc  dico  si  vulnus  intestini 
sic  (sit)  ex  transz'crso. 

Apparently  Gilbert  feels  some  compunctions  of  conscience  rela- 
tive to  the  ultimate  disposition  of  the  canula  of  alder-wood,  and 
permits,  if  he  does  not  advise,  its  removal  from  the  intestine  before 
the  tightening  of  the  last  stitches. 

Roland  adds  nothing  to  the  text  of  Roger.  But  The  Four 
Masters  (Ouatuor  Magistri,  about  A.  D.  1270)  suggest  that  the 
canula  be  made  of  the  trachea  of  some  animal,  and  add : 

Canellus  autem  per  processum  temporis  putrefit  et  emittur  per 
egestionem,  et  iterum  per  concavitatcm  canclli  transibit  egestio. 

—  64  — 


GlLBERTUS    ANGLICUS 

In  his  further  discussion  of  wounds  of  the  intestine  and  their 
treatment  Gilbert  also  volunteers  the  information  that: 

"Mummy  (shade  of  Lord  Lister!)  is  very  valuable  in  the 
healing  of  wounds  of  the  intestine,  if  applied  with  some  astringent 
powder  upon  the  suture." 

In  amends  for  the  mummy,  however,  we  are  also  introduced  to 
the  practice  of  mediaeval  anaesthesia  by  means  of  what  Gilbert  calls 
the  Confectio  soporifera  (f.  234d),  composed  as  follows: 

R. 

Opii, 

Succi  Jusquiami  (hyoscyami), 

Succi  papaveris  nigri,  vel  ejus  seminis, 

Succi  mandragorae,  vel  ejus  corticis,  vel  pomorum  ipsius  si 

sue co  carueris, 
Foliorum  hederae  arborae   {ivy), 
Succi  mororum  rubi  maturorum, 
Seminis  lactucae, 
Succi  cuseutae  (dodder),  aa.  ounce  I. 

Mix  together  in  a  brazen  vessel  and  place  this  in  the  sun  during 
the  dog-days.  Put  in  a  sponge  to  absorb  the  mixture,  and  then 
place  the  sponge  in  the  sun  until  all  the  moisture  has  evaporated. 
When  an  operation  is  necessary,  let  the  patient  hold  the  sponge  over 
his  nose  and  mouth  until  he  goes  to  sleep,  when  the  operation  may  be 
begun.  To  awaken  the  patient  after  the  operation,  fill  another 
sponge  with  vinegar  and  rub  the  teeth  and  nostrils  with  the  sponge, 
and  put  some  vinegar  in  the  nostrils.  An  anaesthetic  drink  may  also 
be  prepared  as  follows : 
R. 

Seminis  papaveris  albi  et  nigri, 
Seminis  lactucae,  aa.  ounce  I. 

Opii, 

Misconis  (  ,  P°PPy  juice f),  aa.  scruples  I-II,  as 

required. 

The  patient  is  to  be  aroused  as  before. 

On  folio  180d  we  find  a  chapter  entitled  "De  cathena  gulae 
incisa  vel  fracta,"  and  copied  almost  literally  from  the  chapter  "De 
catena  gulae"  of  Roger.  In  neither  writer  do  I  find  any  precise 
definition  of  what  the  cathena  gulae  is,  though  Roger  says,"  Si  es 

—  65  — 


GlLBERTUS    ANGLICUS 

gulae,  quod  est  catena,  fractum  fuerit,  etc.,  nor  do  I  find  the  terms 
used  explained  in  any  dictionary  at  present  available.  The  descrip- 
tion of  the  treatment  of  this  fracture  seems,  however,  to  indicate 
that  the  catena  gulae  of  Roger  and  Gilbert  is  what  we  call  the 
clavicle,  though  the  more  common  Latin  names  of  this  bone  are 
clavkulus,  furcula,  juglum  or  os  juguli.  Gilbert  says :  "But  if  the 
bone  which  is  the  cathena  gulae  is  broken  or  in  any  way  displaced 
(recesserit) ,  let  the  physician  with  one  hand  raise  the  forearm 
(brachium)  or  arm  (humerum)  of  the  patient,  and  with  the  other 
hand  press  down  Upon  the  projecting  portion  of  the  bone.  Then 
apply  a  pledget  moistened  with  albumen,  a  pad  and  a  splint  in  form 
of  a  cross,  and  over  all  a  long  bandage  embracing  both  the  arm  and 
the  neck  and  suspending  the  arm.  A  pad  (cervical)  should  also  be 
placed  in  the  axilla  to  prevent  the  dropping  of  the  arm,  and  should 
not  be  removed  until  the  fracture  is  repaired.  If  the  fracture  is 
compound,  the  wound  of  the  soft  parts  is  to  be  left  open  and  un- 
covered by  the  bandage,  so  that  a  tent  (stuellus)  may  be  inserted, 
and  the  wound  is  then  to  be  dressed  in  the  ordinary  manner. 

Simple  fracture  of  the  humerus,  Gilbert  tells  us,  is  to  be  re- 
duced (ad  proprium  locum  reducator)  at  once  by  grasping  the  arm 
above  and  below  the  seat  of  fracture  and  exercising  gentle  and 
gradual  extension  and  compression.  Then  four  pieces  of  lint  wet  in 
egg-albumen  are  to  be  placed  around  the  arm  on  all  sides,  a  band- 
age, four  fingers  wide,  also  moistened  in  albumen  is  to  be  snugly 
applied,  another  dry  bandage  placed  above  this,  and  finally  splints 
fastened  in  position  by  cords.  This  dressing  is  to  remain  un- 
disturbed for  three  days,  and  then  renewed  every  third  day  for  nine 
days.  After  the  ninth  day  a  strictura  (cast,  apparatus  immobile  ?) 
is  to  be  prepared  and  firmly  applied  with  splints  and  a  bandage,  and 
the  patient  is  to  be  cautioned  not  to  bear  any  weight  upon  the  in- 
jured arm  (ne  infirmus  se  super  illud  appodiet  ?).  The  fracture  is 
then  left  until  it  is  believed  that  consolidation  has  occurred.  If, 
however,  it  is  found  that  swelling  is  occasioned  by  the  cast  (ex 
strictorio  ?),  the  latter  should  be  removed,  and  the  arm  well  bathed 
in  warm  water  containing  mallowae  and  other  emollients  and  thor- 
oughly cleansed.  If  the  bone  seems  to  be  well  consolidated,  it 
should  be  rubbed  with  an  ointment  of  dialthea  or  the  unguentum 
marciation,  after  which  the  splints  and  bandage  are  to  be  reapplied. 
If,  however,  it  is  found  that  the  bone  is  not  well  consolidated,  the 
cast  should  be  replaced  in  the  original  manner,  until  consolidation 

—  66  — 


GlLBERTUS    ANGLICUS 

is  accomplished.  If  erysipelas  results  from  the  dressings,  it  is  to 
be  treated  in  the  ordinary  manner.  During  the  entire  treatment 
potions  of  nasturtium  seeds,  pes  columbini  (crowfoot)  and  other 
"consolidatives"  are  to  be  administered  diligently.  If  the  fracture 
is  compound,  any  loose  fragments  of  bone  are  to  be  removed,  the 
fracture  reduced  as  before,  and  similar  dressings  applied,  perforated, 
however,  over  the  wound  in  the  soft  parts. 

In  fracture  of  the  ribs  (flexura  costi)  Gilbert  recommends  a 
somewhat  novel  plan  for  the  replacement  of  the  displaced  bone. 
Having  put  the  patient  in  a  bath,  the  physician  rubs  his  hands  well 
with  honey,  turpentine,  pitch  or  bird-lime  (visco),  applies  his  sticky 
palms  over  the  displaced  ribs,  and  gradually  raises  them  to  their 
normal  position.  He  also  says  (f.  183a),  the  application  of  a  dry 
cup  {cuff a  vero  cum  igne  ?)  over  the  displaced  rib  is  a  convenient 
method  for  raising  it  into  position. 

Of  fractures  of  the  forearm  Gilbert  simply  says  that  they  are 
to  be  recognized  by  the  touch  and  a  comparison  of  the  injured  with 
the  sound  arm.  They  should  be  diligently  fomented,  extension  made 
if  necessary,  and  then  treated  like  other  fractures. 

Dislocation  of  the  atlo-axoid  articulation  (os  juguli)  he  tells  us 
threatens  speedy  death.  The  mouth  of  the  patient  is  to  be  kept 
open  by  a  wooden  gag,  a  bandage  passed  beneath  the  jaw  and  held 
by  the  physician,  who  places  his  feet  upon  the  shoulders  of  the 
patient  and  pressing  down  upon  them  while  he  elevates  the  head  by 
the  bandage,  endeavors  to  restore  the  displaced  bone  to  its  normal 
position.    Inunctions  of  various  mollitives  are  then  useful. 

Dislocations  of  the  lower  jaw  are  recognized  by  the  failure  of 
the  teeth  to  fit  their  fellows  of  the  upper  jaw,  and  by  the  detection 
of  the  condyles  of  the  jaw  beneath  the  ears.  The  bone  is  to  be 
grasped  by  the  rami  and  dragged  down  until  the  teeth  resume  and 
retain  their  natural  position,  and  the  jaw  is  then  to  be  kept  in  place 
by  a  suitable  bandage. 

In  dislocation  of  the  humerus  the  patient  is  to  be  bound  in  the 
supine  position,  a  wedge-shaped  stone  wrapped  with  yarn  placed  in 
the  axilla,  and  the  surgeon,  pressing  against  the  padded  stone  with 
his  foot  and  raising  the  humerus  with  his  hands,  reduces  the  head 
of  the  bone  to  its  natural  position.  If  this  method  fails,  a  long 
crutch-like  stick  is  prepared  to  receive  at  one  end  the  axillary  pad, 
the  patient  is  placed  standing  upon  a  box  or  bench,  the  pad  and 

—  67  — 


GlLBERTUS    ANGLICUS 

crutch  adjusted  in  the  axilla,  and  while  the  surgeon  stands  ready  to 
guide  the  dislocated  bone  to  its  place,  his  assistants  remove  the 
bench,  leaving  the  patient  suspended  by  his  shoulder  upon  the  rude 
crutch.  In  boys,  Gilbert  tells  us,  no  special  apparatus  is  required. 
The  surgeon  merely  places  his  doubled  fist  in  the  axilla,  with  the 
other  hand  grasps  the  humerus  and  lifts  the  boy  off  the  ground,  and 
the  head  of  the  bone  slips  readily  back  into  place.  After  we  are 
assured  that  the  reduction  is  complete,  a  strictorium  is  prepared, 
consisting  of  the  pulvis  ruber,  egg-albumen  and  a  little  wheat  flour, 
with  which  the  shoulder  is  to  be  rubbed.  Finally,  when  all  seems 
to  be  going  on  well,  warm  spata  drapum  (sparadrap)  is  to  be  ap- 
plied upon  a  bandage,  and  if  necessary  the  apostolicon  ointment. 

Dislocation  of  the  elbow  is  reduced  by  passing  a  bandage 
around  the  bend  of  the  arm,  forming  in  this  a  loop  (scapham)  into 
which  the  foot  of  the  surgeon  is  to  be  placed  for  counter-extension, 
while  with  the  hands  extension  is  to  be  made  upon  the  forearm  un- 
til the  bones  are  drawn  into  their  normal  position.  Flexion  and 
extension  of  the  joint  are  then  to  be  practised  three  or  four  times 
(to  assure  complete  reduction  ?),  and  the  forearm  flexed  and  sup- 
ported by  a  bandage  from  the  neck.  After  a  few  days,  Gilbert  tells 
us,  the  patient  will  himself  often  try  to  flex  and  extend  the  arm, 
and  the  bandage  should  be  so  applied  as  not  to  interfere  with  these 
movements. 

Dislocation  of  the  wrist  is  reduced  by  gentle  extension  from  the 
hand  and  counter-extension  from  the  forearm,  and  dislocation  of 
the  fingers  by  a  similar  manipulation. 

After  so  full  a  consideration  of  the  surgical  injuries  of  the 
head,  trunk  and  upper  extremities,  we  are  somewhat  surprised  to 
find  Gilbert's  discussion  of  the  similar  injuries  of  the  lower  ex- 
tremities condensed  into  a  single  very  moderate  chapter  entitled  "De 
vulneribus  cruris  et  tybie"'  (f.  358a b). 

In  this,  Gilbert,  emphasizing  the  importance  of  wounds  of  the 
patella  and  knee-joint  and  the  necessity  for  their  careful  treatment, 
also  declares  that  wounds  of  both  the  leg  and  thigh  within  three 
inches  of  the  joints,  or  in  the  fleshy  portion  of  the  thigh  ubi  organum 
est  ( ?),  involve  considerable  danger.  He  then  speaks  of  a  blackish, 
hard  and  very  painful  tumor  of  the  thigh,  which,  when  it  ascends 
the  thigh  (ad  superiora  asccndit)  is  mortal,  but  if  it  descends  is  less 
dangerous.  Separation  of  the  sacrum  (vertebrum)  from  the  ilium 
(scia),  either  by  accident  or  from  the  corrosion  of  humors,  leaves 

—  68  — 


I  rILBERTUS    AnGLICUS 

the  patient  permanently  lame,  though  suitable  fomentations  and 
inunctions  may  produce  some  improvement.  Sprains  of  the  ankle 
are  to  be  treated  by  placing  the  joint  immediately  in  very  cold  water 
ad  repercussionem  spiritus  et  sanguinis,  and  the  joint  is  to  be  kept 
thus  refrigerated  until  it  even  becomes  numb  (stupef actionem)  ; 
after  which  stupes  of  salt  water  and  urine  are  to  be  applied,  followed 
by  a  plaster  of  galbanum,  opoponax,  the  apostolicon,  etc. 

Fractures  of  the  femur  are  to  be  treated  like  those  of  the 
humerus,  except  that  the  ends  of  the  fractured  bone  are  to  be  sep- 
arated by  the  space  of  an  inch,  and  a  bandage  six  fingers  in  width 
carefully  applied.  Such  fractures  within  three  inches  of  the  hip  or 
knee-joint  are  regarded  as  specially  dangerous. 

Dislocations  of  the  ankle,  after  reduction  of  proper  manipula- 
tion, should  be  bound  with  suitable  splints.  If  of  a  less  severe 
character,  the  dislocation  may  be  dressed  with  stupes  of  canabina 
(Indian  hemp),  urine  and  salt  water,  which  greatly  mitigate  the 
pain  and  swelling.  Afterwards  the  joint  should  be  strapped  for 
four  or  five  inches  above  the  ankle  with  plaster,  nt  prohibeatur 
fluxus. 

It  should  be  said  that  the  brevity  of  this  chapter  of  Gilbert  is 
modeled  after  the  manner  of  Roger  of  Parma,  who  refers  the  treat- 
ment of  injuries  of  the  lower  extremities  very  largely  to  that  of 
similar  injuries  of  the  upper,  merely  adding  thereto  such  explana- 
tions as  may  be  demanded  by  the  differences  of  location  and  func- 
tion of  the  members  involved.  Thus  in  his  discussion  of  dislocation 
of  the  femur  Roger  says : 

Si  cms  a  coxa  sit  disjunctum,  eadem  sit  cura  quam  et  in  dis- 
juncturam  brachii  et  cubiti  diximns,  etc. 

The  general  subject  of  fistulae  is  treated  at  considerable  length 
on  folio  205b,  and  fistula  lachrymalis  and  fistulae  of  the  jaw  receive 
special  attention  in  their  appropriate  places.  As  a  rule,  the  fistula 
is  dilated  by  a  tent  of  alder-pith,  mandragora.  briony  or  gentian, 
the  lining  membrane  destroyed  by  an  ointment  of  quick-lime  or  even 
the  actual  cautery,  and  the  wound  then  dressed  with  egg-albumen 
followed  by  the  unguentum  viride.  Necrosed  bone  is  to  be  removed, 
if  necessary,  by  deep  incisions,  and  decayed  teeth  are  to  be  ex- 
tracted. 

The  elongated  uvula  is  to  be  snipped  off,  and  abscesses  of  the 
tonsils  opened  tout  comme  chez  nous. 

—  69  — 


GlLBERTUS    ANGL1CUS 

An  elaborate  discussion  of  the  subject  of  hernia  is  given  under 
the  title  "De  relaxatione  siphac  et  ruptura"  (f.  280c) — siphac  being 
the  Arabian  name  for  the  peritoneum.  Gilbert  tells  us  the  siphac  is 
sometimes  relaxed,  sometimes  ruptured  (crepatur  ?)  and  sometimes 
inflated.  He  had  seen  a  large  rupture  {crepatur a)  in  which  it  was 
impossible  to  restore  the  intestines  to  the  cavity  of  the  abdomen  in 
consequence  of  the  presence  in  them  of  large  hard  masses  of  fecai 
matter,  which  no  treatment  proved  adequate  to  remove,  and  which 
finally  occasioned  the  death  of  the  patient.  Rupture  of  the  siphac 
is  most  frequently  the  result  of  accident,  jumping,  straining  in  lift- 
ing or  carrying  heavy  weights,  or  in  efforts  at  defecation,  or  of 
shouting  in  boys  or  persons  of  advanced  age,  or  even  in  excessive 
weeping,  etc.  It  is  distinguished  from  hernia  by  the  fact  that  In 
hernia  pain  is  felt  in  the  testicle,  radiating  to  the  kidneys,  while  in 
rupture  of  the  siphac  a  swelling  on  one  side  of  the  pubes  extends 
into  the  scrotum,  where  it  produces  a  tumor  not  involving  the 
testicle.  Rupture  of  the  siphac,  he  says,  is  a  lesion  of  the  organs 
of  nutrition,  hernia  a  disease  of  the  organs  of  generation.  Accord- 
ingly, in  the  pathology  of  Gilbert,  the  term  hernia  is  applied  to 
hydrocele,  orchitis  and  other  diseases  of  the  testicle,  and  not,  as  with 
us  to  protrusions  of  the  viscera  through  the  walls  of  their  cavities. 

In  young  persons,  he  tells  us,  recent  ruptures  of  the  siphac  may 
be  cured  by  appropriate  treatment.  The  patient  is  to  be  laid  upon 
his  back,  the  hips  raised,  the  intestines  restored  to  the  abdominal 
cavity  and  the  opening  of  exit  dressed  with  a  plaster  of  exsiccative 
and  consolidating  remedies,  of  which  he  furnishes  a  long  and  diver- 
sified catalogue.  He  is  also  to  avoid  religiously  all  exercise  or  mo- 
tion, all  anger,  clamor,  coughing,  sneezing,  equitation,  cohabitation, 
etc.,  and  to  lie  with  his  feet  elevated  for  forty  days,  until  the  rup- 
ture {crepatura)  is  consolidated.  The  bowels  are  to  be  kept  soluble 
by  enemata  or  appropriate  medicines,  and  the  diet  should  be  selected 
so  as  to  avoid  constipation  and  flatulence.  A  bandage  or  truss 
(bracale  vel  colUgar)  made  of  silk  and  well  fitted  to  the  patient  is 
also  highly  recommended.  If  the  patient  is  a  boy,  cakes  (crispclle  ?) 
of  cons  olid  a  major  mixed  with  the  yolk  of  eggs  should  be  admin- 
istered, one  each  day  for  nine  days  before  the  wane  of  the  moon. 
If,  however,  the  rupture  is  large  in  either  a  boy  or  an  adult,  and  of 
long  standing,  whether  the  intestine  descends  into  the  scrotum  or 
not,  operation,  either  by  incision  or  by  the  cautery  offers  the  only 
hope  of  relief.     Singularly  enough  too,  while  Roger  devotes  to  the 

—  70  — 


GlLBERTUS    ANGLICUS 

operation  for  the  cure  of  hernia  nearly  half  a  page  of  his  text,  Gil- 
bert dismisses  the  whole  subject  in  a  single  sentence,  as  follows : 

Scindatur  igitur  tolus  exitus  super  hac  cute  exteriori  cum  came 
fissa,  et  uatur  y  fac  cum  file  serice  et  acu  quadrat  a.  Deinde  per- 
sequere  ut  in  exitu  intestini  per  vulnus  superius  demonstratum  est 
(f.  281d). 

Turning  now  to  the  title  "De  hernia"  (f.  289b),  Gilbert  tells  us 
"Swelling  (inflatio)  of  the  testicles  is  due  sometimes  to  humors 
trickling  down  upon  them  (rheumatisantibus) ,  sometimes  to  ab- 
scess, or  to  gaseous  collections  (ventositate),  and  sometimes  to 
escape  of  the  intestines  through  rupture  of  the  siphac."  He  adds 
also:  "Some  doubt  the  propriety  of  using  the  term  hernia  for  an 
inflation.  On  this  point  magister  Rn  says:  There  is  a  certain 
chronic  and  inveterate  tumor  of  the  testicles,  which  is  never  cured 
except  by  means  of  surgery,  as  e.g.,  hernia.  For  hernia  is  an  affec- 
tion common  to  the  scrotum  and  the  testicles." 

The  apparent  confusion  between  these  two  passages  is  easily 
relieved  by  the  explanation  that  inguinal  or  other  herniae  not  ex- 
tending into  the  scrotum  are  called  by  Gilbert  ruptures  of  the  siphac, 
but  scrotal  hernia  is  classed  with  other  troubles  located  in  the 
scrotum  as  hernia.  Accordingly  hernia,  with  Gilbert,  includes  not 
only  scrotal  hernia,  but  also  hydrocele,  orchitis,  tumors  of  the  testi- 
cles, etc.  This  is  apparent,  too,  in  his  treatment  of  hernia,  which 
consists  usually  in  the  employment  of  various  poultices  and  oint- 
ments, bleeding  from  the  saphena,  cups  over  the  kidneys,  etc., 
though  hydrocele  is  tapped  and  a  seton  inserted.  If  the  testicle 
itself  is  "putrid,"  it  should  be  removed ;  otherwise  it  is  left.  It  may 
be  remarked  en  passant  that  the  surgeons  of  medieval  times,  in  their 
desire  for  thoroughness,  often  displayed  very  little  respect  to  what 
Baas  calls  "the  root  of  humanity." 

We  will  terminate  our  hasty  review  of  diseases  discussed  in  the 
Compendium  by  an  abstract  of  Gilbert's  views  on  vesical  calculus 
and  its  treatment,  which  cover  more  than  fifteen  pages  of  his  work. 

Stone  and  gravel  arise  from  various  viscous  superfluities  in  the 
kidneys  and  bladder,  which  occasion  difficulty  in  micturition.  Stone 
is  produced  by  the  action  of  heat  upon  viscous  moisture,  sublimating 
the  volatile  elements  and  condensing  the  denser  portions.  Putrefica- 
tion  of  stone  in  the  bladder  is  the  result  of  three  causes,  viz.,  con- 
suming heat,  viscous  matter  and  stricture  of  the  meatus.     For  con- 

—  71  — 


GlLBERTUS    ANGLICUS 

suming  heat  acting  on  viscous  material  retained  by  reason  of  strict- 
ure of  the  meatus,  by  long  action  dries  up,  coagulates  and  hardens 
the  moisture.  This  is  particularly  manifest  in  boys  who  have  a  con- 
stricted meatus. 

Stones  are  thus  generated  not  only  in  the  kidneys  and  bladder, 
but  also  even  in  the  stomach  and  the  intestines,  whence  they  are 
ejected  by  vomiting  or  in  the  stools.  Indeed  they  may  also  be  found 
occasionally  in  the  lungs,  the  joints  and  other  places.  They  are 
comparatively  rare  in  women,  in  consequence  of  the  shortness  ot 
the  urethra  and  the  size  of  their  meatus. 

Sometimes  calculi  occur  in  the  bladder,  sometimes  in  one  kidney 
and  occasionally  in  both  kidneys.  The  symptoms  produced  by  their 
presence  vary  in  accordance  with  the  situation  of  the  concretion.  If 
the  stone  is  in  the  kidney,  the  foot  of  the  side  affected  is  numb 
(stupidus) ,  the  spine  on  the  affected  side  is  sore  and  there  is  diffi- 
culty of  micturition  and  considerable  gravelly  sediment  in  the  urine. 
If  the  stone  is  increasing  in  size,  the  quantity  of  sediment  also  in- 
creases, but  if  the  stone  is  fully  formed  and  confirmed,  the  amount 
of  sediment  decreases  daily,  and  the  urine  becomes  milky  both  in 
the  kidneys  and  the  bladder.  A  stone  in  the  bladder  occasions  very 
similar  symptoms,  together  with  pain  in  the  peritoneum  and  pubes, 
dysuria  and  strangury,  and  sometimes  the  appearance  of  blood  and 
flocculi  (trumbos?)  in  the  urine.  Patients  suffering  from  vesical 
calculus  are  always  constipated,  and  the  dysuria  may  increase  to  the 
degree  called  furia,  a  condition  not  without  some  danger. 

Three  things  are  necessary  in  the  cure  of  stone,  viz.,  a  spare  and 
simple  diet,  the  use  of  diuretics  and  a  moderate  amount  of  exercise. 
It  should,  however,  be  remarked  that  confirmed  stone  is  rarely  or 
never  cured,  except  by  a  surgical  operation.  ...  If  a  boy 
has  a  clear  and  watery  urine  after  it  has  been  sandy,  if  he  frequently 
scratches  his  foot,  has  involuntary  erections  and  finally  obstruction 
in  micturition,  I  say  that  he  has  a  stone  in  the  neck  of  his  bladder. 
If  now  he  be  laid  upon  his  back  with  his  feet  well  elevated,  and  his 
whole  body  be  well  shaken,  if  there  is  a  stone  present  it  is  possible 
that  it  may  fall  to  the  fundus  of  the  bladder.  Afterwards  direct 
the  boy  to  bear  down  (ut  exprimat  se)  and  try  to  make  water.  If 
this  treatment  turns  out  in  accordance  with  your  theory,  the  urine 
necessarily  escapes  and  your  idea  and  treatment  are  confirmed.  If, 
however,  the  urine  does  not  escape,  let  the  boy  be  shaken  vigorously 
a  second  time.     If  this  too  fails  and  strangury  ensues,  it  will  be 

—  72  — 


GlLBERTUS    ANGLICUS 

necessary  to  resort  to  the  use  of  a  sound  or  catheter  (argaliam), 
so  that  when  the  stone  is  pushed  away  from  the  neck  of  the  bladder 
the  passage  may  be  opened  and  the  urine  may  flow  out.  It  may  be 
possible  too  that  no  stone  exists,  but  the  urethra  is  obstructed  or 
closed  by  pure  coagulated  blood.  Perhaps  there  may  have  been  a 
wound  of  the  bladder,  although  no  external  haemorrhage  has  ap- 
peared, but  the  blood  coagulating  gradually  in  the  bladder  has  oc- 
casioned an  obstruction  or  narrowing  of  the  urinary  passage.  Or 
possibly  the  blood  from  a  renal  haemorrhage  has  descended  into  the 
bladder  and  obstructs  the  urethra.  Hence  I  say  that  the  sound  is 
useful  in  these  cases  where  the  urethra  is  obstructed  by  blood  or 
gross  humors.  Examination  should  also  be  made  as  to  whether  a 
fleshy  body  exists  in  the  bladder,  as  the  result  of  some  wound.  This 
condition  is  manifest  if,  on  the  introduction  of  the  sound',  the  urine 
flows  out  promptly.  I  once  saw  a  man  suffering  from  this  con- 
dition, who  complained  of  severe  pain  in  the  urinary  passage  as  I 
was  introducing  the  sound,  and  I  recognized  that  there  were  wounds 
in  the  same  part,  for  as  soon  as  these  were  touched  by  the  sound 
the  urine  began  to  flow,  followed  soon  after  by  a  little  blood  and 
fleshy  particles.  .  .  .  So  far  as  the  operation  of  physicians  is 
concerned,  it  is  necessary  only  to  be  certain  of  the  fact  that  ob- 
struction to  the  passage  of  urine  depends  upon  no  other  cause  than 
stone  or  the  presence  of  coagulated  blood  (f.  271). 

Gilbert's  medical  treatment  of  vesical  calculus  consists  generally 
in  the  administration  of  diuretics  and  lithontriptics  and  the  local 
application  of  poultices,  plasters  and  inunctions  of  various  kinds. 
Of  the  lithontriptics,  certain  combinations,  characterized  by  famous 
names  or  notable  historical  origin,  are  evident  favorites.  Among 
this  class  we  read  of  the  Philoantropos  major  and  minor,  the  Jus- 
tinum,  the  Usina  "approved  by  many  wise  men  of  Babylon  and  Con- 
stantinople," the  Lithontripon  and  the  "Pulvis  Engenii  pape,"  with 
numerous  others. 

Rather  curiously  and  suggestively  no  mention  is  made  in  this 
immediate  connection  of  the  technique  of  lithotomy.  On  a  later 
page,  however  (f.  309a),  we  find  a  chapter  entitled  "De  cura  lapidis 
per  cyrurgiam,"  in  which  Gilbert  writes : 

"Mark  here  a  chapter  on  the  cure  of  stone  in  the  bladder  by 
means  of  surgery,  which  we  have  omitted  above.  Accordingly,  to 
determine  whether  a  stone  exists  in  the  bladder,  let  the  patient  take 
a  warm  bath.     Then  let  him  be  placed  with  his  buttocks  elevated, 

—  73  — 


(  tILBERTUS  Anglicus 

and,  having  inserted  into  the  anus  two  fingers  of  the  right  hand, 
press  the  fist  of  the  left  hand  deeply  above  the  pubes  and  lift  and 
draw  the  entire  bladder  upward.  If  you  find  anything  hard  and 
heavy,  it  is  manifest  that  there  is  a  stone  in  the  bladder.  If  the 
body  feels  soft  and  fleshy,  it  is  a  fleshy  excrescence  (carnositas) , 
which  impedes  the  flow  of  urine.  Now,  if  the  stone  is  located  in 
the  neck  of  the  bladder  and  you  wish  to  force  it  to  the  fundus: 
after  the  use  of  fomentations  and  inunctions,  inject  through  a 
svringe  (siringa)  some  petroleum,  and  after  a  short  interval  pass 
the  syringe  again  up  to  the  neck  of  the  bladder  and  cautiously  and 
gently  push  the  stone  away  from  the  neck  to  the  fundus.  Or,  which 
is  safer  and  better,  having  used  the  preceding  fomentations  and  in- 
unctions, and  having  assured  yourself  that  there  is  a  stone  in  the 
bladder,  introduce  your  fingers  into  the  anus  and  compress  the 
neck  of  the  bladder  with  the  fist  of  the  left  hand  above  the  pubes, 
and  cautiously  remove  the  stone  and  guide  it  to  the  fundus.  But  if 
you  wish  to  extract  the  stone,  let  a  spare  diet  precede  the  operation, 
and  let  the  patient  lie  abed  for  a  couple  of  days  with  very  little  food. 
On  the  third  day  introduce  the  fingers  into  the  anus  as  before,  and 
draw  down  the  stone  into  the  neck  of  the  bladder.  Then  make  your 
incision  lengthwise  in  the  fontanel,  the  width  of  two  fingers  above 
the  anus,  and  extract  the  stone.  For  nine  days  after  the  operation 
let  the  patient  use,  morning  and  evening,  fomentations  of  branca 
(acanthus  mollis),  paritaria  (pellitery)  and  malva  (mallows).  A 
bit  of  tow  (stupa)  moistened  with  the  yolk  of  egg  in  winter,  and 
with  both  the  yolk  and  white  of  egg  in  summer,  is  to  be  placed  over 
the  wound.  Proud  flesh,  which  often  springs  up  near  a  wound  in 
the  neck  of  the  bladder,  should  be  removed  by  the  knife  (rasorio), 
and  two  or  three  sutures  inserted.  The  wound  is  then  to  be  treated 
like  other  wounds.  It  should  be  remarked,  however,  that  if  the 
stone  is  very  large,  it  should  be  simply  pushed  up  to  the  fundus  of 
the  bladder  and  left  there,  and  no  effort  should  be  made  to  ex- 
tract it." 

This  description  of  the  diagnosis  of  stone  and  of  the  operation 
of  lithotomy  is  copied  almost  literally  from  Roger  of  Parma. 

Sufficient  (perhaps  more  than  enough)  has  been  written  to 
give  the  reader  a  fair  idea  of  the  general  character  of  Gilbert's 
"Compendium  Medicine." 

A  few  words  may  be  added  with  reference  to  the  proper  place 
of  the  work  in  our  medical  literature. 

—  74  — 


GlLBERTUS   ANGLICUS 

It  is  not  difficult,  of  course,  to  select  from  the  Compendium  a 
charm  or  two,  a  few  impossible  etymologies  and  a  few  silly  state- 
ments, to  display  these  with  a  witty  emphasis  and  to  draw  there- 
from the  easy  conclusion  that  the  book  is  a  mass  of  crass  supersti- 
tion and  absurd  nonsense.  This,  however,  is  not  criticism.  It  is 
mere  caricature. 

To  compare  the  work  with  the  teachings  of  modern  medicine  is 
not  only  to  expect  of  the  writer  a  miraculous  prescience,  but  to 
minimize  the  advances  of  medical  science  within  the  last  seven  hun- 
dred years. 

Even  Freind  and  Sprengel,  admirable  historians,  though  more 
thoughtful  and  judicious  in  their  criticisms,  seem  for  the  moment  to 
have  forgotten  or  overlooked  the  true  character  of  the  Compendium. 

Freind  says : 

"I  believe  we  may  even  say  with  justice  that  he  (Gilbert)  has 
written  as  well  as  any  of  his  contemporaries  of  other  nations,  and 
has  merely  followed  their  example  in  borrowing  very  largely  from 
the  Arabians,"  and  Sprengel  writes :  "Here  and  there,  though  only 
very  rarely,  the  author  offers  some  remarks  of  his  own,  which  merit 
special  attention." 

Now,  what  precisely  is  Gilbert's  Compendium  designed  to  be? 
In  the  words  of  its  author  it  is 

*'A  book  of  general  and  special  diseases,  selected  and  extracted 
from  the  writings  of  all  authors  and  the  practice  of  the  professors 
(magistrorum) ,  edited  by  Gilbert  of  England  and  entitled  a  Com- 
pendium of  Medicine," 
and  a  few  pages  later  he  adds : 

"It  is  our  habit  to  select  the  best  sayings  of  the  best  authorities, 
and  where  any  doubt  exists,  to  insert  the  different  opinions,  so  that 
each  reader  may  choose  for  himself  what  he  prefers  to  maintain." 

The  author  does  not  claim  for  his  work  any  considerable  orig- 
inality, but  presents  it  as  a  compendium  proper  of  the  teachings  of 
other  writers.  Naturally  his  own  part  in  the  book  is  not  obtruded 
upon  our  notice. 

Now  the  desiderata  of  such  a  compendium  are : 

1.  That  it  shall  be  based  upon  the  best  attainable  authorities. 

2.  That  these  authorities  shall  be  accurately  represented. 

3.  That  the  compendium  shall  be  reasonably  comprehensive. 


GlLBERTUS   ANGLICUS 

In  neither  of  these  respects  is  the  compendium  of  Gilbert  liable, 
I  think,  to  adverse  criticism. 

The  book  is,  undoubtedly,  the  work  of  a  famous  and  strictly- 
orthodox  physician,  possessed  of  exceptional  education  in  the  science 
of  his  day,  a  man  of  wide  reading,  broadened  by  extensive  travel 
and  endowed  with  the  knowledge  acquired  by  a  long  experience, 
honest,  truthful  and  simple  minded,  yet  not  uncritical  in  regard  to 
novelties,  firm  in  his  own  opinions  but  not  arrogant,  sympathetic, 
possessed  of  a  high  sense  of  professional  honor,  a  firm  believer  in 
authority  and  therefore  credulous,  superstitious  after  the  manner  of 
his  age,  yet  harboring,  too,  a  germ  of  that  healthy  skepticism  which 
Roger  Bacon,  his  great  contemporary,  developed  and  illustrated. 

I  believe,  therefore,  that  we  may  justly  award  to  the  medical 
pages  of  the  Compendium  not  only  the  rather  negative  praise  of 
being  written  as  well  as  the  work  of  any  of  Gilbert's  contemporar- 
ies, but  the  more  positive  credit  of  being  thoroughly  abreast  of  the 
medical  science  of  its  age  and  country,  an  "Abstract  and  brief 
chronicle  of  the  time.''" 

The  surgical  chapters  of  the  work  are  unique  in  a  compendium 
of  medicine,  and  merit  even  more  favorable  criticism. 

The  discouragement  of  the  practice  of  medicine  and  surgery  on 
the  part  of  ecclesiastics  by  the  popes  and  church  councils  of  the 
twelfth  century,  culminating  in  the  decree  of  Pope  Innocent  III  in 
1215,  which  forbade  the  participation  of  the  higher  clergy  in  any 
operation  involving  the  shedding  of  blood  (Ecclesia  abhorret  a 
sanguine)  ;  the  relatively  scanty  supply  of  educated  lay  physicians 
and  surgeons,  and  finally  the  pride  and  inertia  of.  the  lay  physicians 
themselves;  all  these  combined  to  relegate  surgery  in  the  thirteenth 
century  to  the  hands  of  a  class  of  ignorant  and  unconscionable  em- 
pirics, whose  rash  activity  shed  a  baleful  light  upon  the  art  of  sur- 
gery itself.  As  a  natural  result  the  practice  of  this  art  drifted  into 
an  impasse,  from  which  the  organization  of  the  barber-surgeons 
seemed  the  only  logical  means  of  escape. 

The  earliest  evidence  of  the  public  surgical  activity  of  the  bar- 
bers, as  a  class,  is  found,  I  believe,  in  Joinville's  Chronicle  of  the 
Crusade  of  St.  Louis  (Louis  IX)  in  the  year  1250.  According  to 
Malgaigne,  no  trustworthy  evidence  of  any  organization  of  the  bar- 
bers of  Paris  is  available  before  1301,  and  the  fraternity  was  not 
chartered  until  1427,  under  Charles  VII.  The  barbers  of  London 
are  noticed  in  1308,  and  they  received  their  charter  from  Edward 

—  76  — 


GlLBERTUS    ANGLICUS 

IV  in  1462,  The  parallel  lines  upon  which  the  confraternities  of  the 
two  cities  developed  is  very  noticeable — making  due  allowance  for 
Gallic  enthusiasm  and  bitterness. 

Lanfranchi,  the  great  surgeon  of  Paris,  about  the  year  1300  is 
moved  to  write  as  follows : 

"Why,  in  God's  name,  in  our  days  is  there  such  a  great  differ- 
ence between  the  physician  and  the  surgeon?  The  physicians  have 
abandoned  operative  procedures  to  the  laity,  either,  as  some  say, 
because  they  disdain  to  operate  with  their  hands,  or  rather,  as  I 
think,  because  they  do  not  know  how  to  perform  operations.  In- 
deed, this  abuse  is  so  inveterate  that  the  common  people  look  upon  it 
as  impossible  for  the  same  person  to  understand  both  surgery  and 
medicine.  It  ought,  however,  to  be  understood  that  no  one  can  be 
a  good  physician  who  has  no  idea  of  surgical  operations,  and  that  a 
surgeon  is  nothing  if  ignorant  of  medicine.  In  a  wTord,  one  must 
be  familiar  with  both  departments  of  medicine." 

Now  Gilbert  by  the  incorporation  of  many  chapters  on  surgery 
in  his  Compendium  inculcates  practically  the  same  idea  more  than 
fifty  years  before  Lanfranchi,  and  may  claim  to  be  the  earliest  rep- 
resentative of  surgical  teaching  in  England.  Malgaigne,  indeed, 
does  not  include  his  name  in  the  admirable  sketch  of  medieval  sur- 
gery with  which  he  introduces  his  edition  of  the  works  of  Ambroise 
Pare,  and  says  Gilbert  was  no  more  a  surgeon  than  Bernard  Gor- 
don. This  is  in  a  certain  sense  true.  Gilbert  was  certainly  not  an 
operative  surgeon.  But  it  needs  only  a  very  superficial  comparison 
of  the  Compendium  of  Gilbert  with  the  Lilium  Medicinae  of  Gor- 
don to  establish  the  fact  that  the  books  are  entirely  unlike.  Indeed, 
it  may  be  truthfully  said  that  Gordon's  work  does  not  contain  a 
single  chapter  on  surgery  proper.  His  cases  involving  surgical 
assistance  are  turned  over  at  once,  and  with  little  or  no  discussion, 
to  those  whom  he  calls  "restauratores"  or  "chirurgi,"  and  his  own 
responsibility  thereupon  ends. 

We  have  no  historical  facts  which  demonstrate  that  Gilbert's 
Compendium  exercised  any  considerable  influence  upon  the  devel- 
opment of  surgery  in  England,  but  when  we  consider  the  depressed 
condition  of  both  medicine  and  surgery  in  his  day,  we  should  cer- 
tainly emphasize  the  clearness  of  vision  which  led  our  author  to 
indicate  the  natural  association  of  these  two  departments  of  the 
healing  art,  and  the  assistance  which  each  lends  to  the  other. 

-77- 


Date  Due 


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2  9  1979 


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